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Phar 506 > Endocarditis and Catheter IInfections > Flashcards

Endocarditis and Catheter IInfections Flashcards

1
Q

What is infective endocarditis

A

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

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2
Q

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

A

Bicuspid/mitral valve, aortic and pulmonary valves, tricuspid

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3
Q

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

A

True

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4
Q

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

A

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

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5
Q

What are ways that bacteria can be introduced to cause endocarditis

A

Indwelling catheters, IV drug abuse, Dental or surgical procedures

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6
Q

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

A

Trans-thoracic vs trans-esophageal, trans- esophageal

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7
Q

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

A

Staphylococcus aureus, streptococci, enterococci, gram negatives

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8
Q

What must be considered to when selecting a drug regimen

A

Sensitivities, biofilm, patient allergies, hepatic/renal fucntion

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9
Q

What streptococci species will cause dosing recommendations based on penicillin resistace

A

Virdans streptococci, streptocccus gallolytics, Abiotrophi defective, granulicatella species

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10
Q

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

A

True

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11
Q

What are the treatment options based on steptococci causing NVE

A

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

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12
Q

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

A

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

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13
Q

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

A

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

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14
Q

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

A

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

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15
Q

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

A

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

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16
Q

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

A

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

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17
Q

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

A

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

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18
Q

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

A

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

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19
Q

What is the most common cause of infective endocarditis

A

Staphylococcus aurues, coagulase-negative staphylococci

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20
Q

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

A

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

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21
Q

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

A

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

22
Q

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

A

Requires 3 drugs

23
Q

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

A

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

24
Q

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

A

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

25
Q

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

A

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

26
Q

What are HACEK organisms that cause NVE

A

Haemophilus species, Aggregatibacter, cardiobacterium, eikenlla, kingella

27
Q

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

A

Ceftriaxone 2 grams over 24 hours IV for 4 weeks

28
Q

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

A

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

29
Q

What combination would be used to treat endocarditis caused by fungi

A

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

30
Q

What patients should receive prophylaxis for endocarditis

A

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

31
Q

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

A

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

32
Q

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

A

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

33
Q

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

A

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

34
Q

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

A

True

35
Q

What are reasons for long-term catheters

A

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

36
Q

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

A

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

37
Q

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

A

coagulse negative staphylococcus, enterococci, staphylococcus aureus, candida species

38
Q

How is catheter induced infections diagnosed

A

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

39
Q

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

A

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

40
Q

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

A

6 to 8 weeks

41
Q

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

A

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

42
Q

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

A

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

43
Q

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

A

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

44
Q

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

A

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

45
Q

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

A

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

46
Q

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

A

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

47
Q

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

A

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

48
Q

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

A

Caspofungin, Flucanozole, Amphotericin/ 14 days

49
Q

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

A

True

50
Q

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

A

True

51
Q

What are good techniques to prevent catheter infections

A

Chlorohexidine use, aesptic barriers, insert in the Vena Cava

Phar 506 (37 decks)

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