Endocarditis and Catheter IInfections

Question 1

What is infective endocarditis

Answer 1

a microbial infection of a platelet-fibrin vegetation on the endothelial surface of the heart, most commonly the valves

Question 2

Where is the place where endocarditis is most likely to occur, where else

Answer 2

Bicuspid/mitral valve, aortic and pulmonary valves, tricuspid

Question 3

T/F: A platelet fibrin deposition is the ideal spot for bacteria to bind and cause endocarditis

Answer 3

True

Question 4

What are the risk factors for developing a thrombus on the heart

Answer 4

Rheumatic heart disease, Congenital heart disease (patent ductus), acquired heart disease (mitral valve prolapse), prosthetic valves, previous bacterial endocarditis

Question 5

What are ways that bacteria can be introduced to cause endocarditis

Answer 5

Indwelling catheters, IV drug abuse, Dental or surgical procedures

Question 6

What echocardiograms are used to aid in diagnosing endocarditis, which is done for obese patients

Answer 6

Trans-thoracic vs trans-esophageal, trans- esophageal

Question 7

What is the most common organism to cause endocarditis, what are the other organisms

Answer 7

Staphylococcus aureus, streptococci, enterococci, gram negatives

Question 8

What must be considered to when selecting a drug regimen

Answer 8

Sensitivities, biofilm, patient allergies, hepatic/renal fucntion

Question 9

What streptococci species will cause dosing recommendations based on penicillin resistace

Answer 9

Virdans streptococci, streptocccus gallolytics, Abiotrophi defective, granulicatella species

Question 10

T/F: Steptococci species are common causes in community-acquired native valve endocardi (NVE) in non-IV Drug Using patients

Answer 10

True

Question 11

What are the treatment options based on steptococci causing NVE

Answer 11

Penicillin sensitive (MIC less than 0.12 mcg/ml), penicillin intermediate (MIC greater than .012 mcg/ml)

Question 12

What are the antibiotics options to treat Native valve endocarditis when it is caused by penicillin susceptible (MIC less than 0.12) streptococci

Answer 12

Penicillin 18 million units over 24 hours IV for 4 weeks OR penicllin 18 million units over 24 hours IV for 2 weeks plus gentamicin 3mg/kg per 24 hours IV for 2 weeks

Question 13

What are the antibiotics options used to treat Native Valve endocarditis when it is caused by penicillin suspceptible (MIC less than 0.12) streptococci BUT the patient has a penicillin allergy

Answer 13

Vancomycin 30 mg/kg per 24 hours IV for 4 weeks

Question 14

What are the antibiotic options used to treat Native Valve endocarditis when it is caused by penicillin resistant (MIC greater than 0.12) streptococci

Answer 14

Penicillin 24 million units over 24 hours IV for 4 weeks plus gentamicin 3mg/kg over 24 hours IV for 2 weeks

Question 15

What are the antibiotic options used to treat Native Valve endocarditis when it is caused by penicillin resistant (MIC greater than 0.12) streptococci BUT the patient has a penicillin allergy

Answer 15

Vancomycin 30 mg/kg per 24 hours IV for 4 weeks

Question 16

What are the antibiotic options used to treat prosthetic valve endocarditis when it is caused by penicillin susceptible (MIC less than 0.12) streptococci

Answer 16

Penicillin 24 million units over 24 hours IV for 6 weeks with or without gentamicin 3 mg/kg over 24 hours IV for 2 weeks

Question 17

What are the antibiotic options used to treat prosthetic valve endocarditis when it is caused by penicillin resistant (MIC greater than 0.12) streptococci

Answer 17

Pencillin 24 million units over 24 hours IV for 6 weeks plus gentamicin 3 mg/kg over 24 hours IV for 6 weeks

Question 18

What are the antibiotic options used to treat prosthetic valve endocarditis when it is caused by penicillin sensitive (MIC less than 0.12) streptococi BUT the patient has a penicillin allergy

Answer 18

Vancomycin 30/mg/kg per 24 hours IV for 6 weeks

Question 19

What is the most common cause of infective endocarditis

Answer 19

Staphylococcus aurues, coagulase-negative staphylococci

Question 20

What are the antibiotic options used to treat native valve endocarditis caused by staphylococci

Answer 20

Nafacillin or Oxacillin 12 grams over 24 hours IV for 6 weeks

Question 21

What are the antibiotic options used to native valve endocarditis caused by staphylococci BUT the patient has penicliin allergy or the strand is Oxacillin resistant

Answer 21

Vancomycin 30 mg/kg per 24 hours IV for 6 weeks

Question 22

What is key about antibiotic treatment of posthetic valve endocarditis caused by Staphylococcus aureas

Answer 22

Requires 3 drugs

Question 23

What are the antibiotic options used to treat prosthetic valve endocarditis caused by staphylococcus aureas is MSSA/oxacillin susceptible

Answer 23

Nacillin or Oxacillin 12 grams over 24 hours IV for greater than 6 weeks PLUS Rifampin 900 mg over 24 hours IV or orally for greater than 6 weeks PLUS gentamicin 3 mg/kg over 24 hours IV for 2 weeks

Question 24

What are the antibiotic options used to treat prosthetic valve endocarditis caused by staphylococcus aureas if MRSA/oxacillin resistant

Answer 24

Vancomycin 30 mg /kg IV over 24 hours for greater than 6 weeks plus Rifampin 900 mg over 24 hours IV or orally for greater than 6 weeks plus gentamicin 3 mg/kg over 24 hours IV for 2 weeks

Question 25

What antibiotic options are used to treat endocarditis caused by enterococci involcing either a native or prosthetic valve

Answer 25

Ampicllin 2 grams IV every 4 hours for 4 to 6 weeks plus gentamicin 3 mg/kg (vancomycin if penicillin allergic)

Question 26

What are HACEK organisms that cause NVE

Answer 26

Haemophilus species, Aggregatibacter, cardiobacterium, eikenlla, kingella

Question 27

What is the antibiotic regimen to treat Endocarditis caused by a HACEK organism

Answer 27

Ceftriaxone 2 grams over 24 hours IV for 4 weeks

Question 28

What antibiotic combination would be used to treat Endocarditis caused by a gram negative bacilli

Answer 28

Beta-lactam plus an aminoglycoside for 6 weeks, with valve replacement

Question 29

What combination would be used to treat endocarditis caused by fungi

Answer 29

Amphotericin B with or without flucytosin until the patient feels better, with valve replacement

Question 30

What patients should receive prophylaxis for endocarditis

Answer 30

Patient has prosthetic valves, previous infective endocarditis, congenital heart disease when there will be dental surgery

Question 31

What prophylatic drug should a patient receive orally, unable to take oral medication, allergic to penicllin, allergic to penicllin and unable to take orally

Answer 31

Amoxicillin 2 grams, Ampicllin 2 grams IV, Clindamycin 600 mg, Clindamycin 600 mg IV

Question 32

What is the difference between catheter-related bacteremia and localized catheter site infection

Answer 32

Same organism isolated from the catheter is the organism that causes systemic infection, infection only at the catheter site

Question 33

How long does a short-term catheter last peripherally, at the mid-line

Answer 33

Good for 2-3 days, good for 1-2 weeks

Question 34

T/F: A catheter on the skin has an increased risk of infection

Answer 34

True

Question 35

What are reasons for long-term catheters

Answer 35

IV drug use, TPNs, chemotherapy, treatment of endocarditis, lives out of the country

Question 36

What are risk factors for acquiring an infection due to catheter use

Answer 36

Cutaneous ports, increased number of lumens manipulated, length of time in place, poor site technique, insection site (jugular and groin)

Question 37

What is the organism that causes the most catheter infections, what are the others

Answer 37

coagulse negative staphylococcus, enterococci, staphylococcus aureus, candida species

Question 38

How is catheter induced infections diagnosed

Answer 38

Catheter tip culture (greater than 15 CFU) PLUS two peripheral blood cultures, all must be the same organism

Question 39

When should the catheter be pulled in treatment of a catheter related infection

Answer 39

Supparative thrombophlebitis, Severe sepsis, Endocarditis, Osteomyelitis, positive blood cultures after 72 hours while receiving antimicrobial therapy

Question 40

How long is treatment if catheter related infection is complicated (i.e supparative thrombophlebitis, severe sepsis, endocarditis, osteomyelitis)

Answer 40

6 to 8 weeks

Question 41

T/F: Treatment is 1 to 2 weeks if a patient has a complicated tunnel infection, port abscess

Answer 41

False: Treatment is 7 to days if a patient has a complicated tunnel infection, port abscess

Question 42

What is the drug, dose, antibiotic lock, and length of therapy is used to treat coagulase -negative staphylococcus that is an uncomplicated catheter infection

Answer 42

Vancomycin 15mg/kg every 12 hours, Vancomycin 2.5 mg/ml plus Heparin 2500 units/ml -3 ml for 10-14 days

Question 43

What is the drug, dose, antibitotic lock, and length of therapy that is used to treat enterococci that is an uncomplicated catheter infection

Answer 43

Vancomycin 15mg/kg every 12 hours, Vancomycin 2.5 mg/ml plus Heparin 2500 units/ml -3 ml for 10- 14 days

Question 44

What is the drug, dose and length of therapy to treat vancomycin resistant enterococci that is an uncomplicated catheter infection

Answer 44

Daptomycin 6 mg/kg/day or Linezolid 600 mg ever 12 hours for 10-14 days

Question 45

What is the drug, dose and length of therapy to treat staphylococcus aureus that is methicillin sensitive in an uncomplicated catheter infection

Answer 45

Naficillin or Oxacillin 1-2 grams IVPB every 4-6 hours for 2-6 weeks

Question 46

What is the drug, dose and length of therapy to treat staphylococcus aureus that is methicillin resistant in an uncomplicated catheter infection

Answer 46

Vancomycin 15 mg/kg every 12 hours OR Daptomycin 6-8 mg/kg every 2-6 weeks

Question 47

What antibiotics can be used to treat gram negative bacilli causing an uncomplicated catheter infection, how long

Answer 47

Piperacillin/tazobactam, ceftazidme, cefipme, imipenem or meropenem +/- an aminoglycoside (10-14 days)

Question 48

What medications are used to treat candida species causing catheter infection, how long

Answer 48

Caspofungin, Flucanozole, Amphotericin/ 14 days

Question 49

T/F: In any complicated catheter infection the line will be removed true

Answer 49

True

Question 50

T/F: In any uncomplicated catheter infection the line will be removed unless it is caused by coagulase-negative streptococcus

Answer 50

True

Question 51

What are good techniques to prevent catheter infections

Answer 51

Chlorohexidine use, aesptic barriers, insert in the Vena Cava