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Therapeutics IV > Endocarditis - Block 2 > Flashcards

Endocarditis - Block 2 Flashcards

1
Q

What is endocarditis?

A

Inflammation of the endocardium (membrane the lining of the chambers of the heart)

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2
Q

What are causes of endocarditis?

A
  1. Vavular endolial damage and colonization
  2. Platelet and fibrin deposits -> nonbacterial throbotic endocarditis (NBTE) -> pressure gradient across the affected valve
  3. Vegetation -> Bloodstream infection or transient bacteremia -> vegetation breaks off -> embolism

Overall heart valve destruction

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3
Q

IE is generally caused by _____ bacteria?

A

G+

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4
Q

What are the common pathogens of IE?

A
  1. S. aureus
  2. Coagulase - staph
  3. Viridians
  4. HACEK
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5
Q

Common pathogens seen in native valves?

A

MSSA >MRSA, Strep, and enterococci

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6
Q

Common pathogens of prosthetic valves?

A

<2 months post op: MRSA>MSSA

>2 months post op: Staph (MSSA>MRSA), strep, enterococci, biofilm of S. aureus

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7
Q

RF of IE?

A
  1. Prostetic heart valve
  2. Hx of IE
  3. IUD
  4. > 60YO
  5. Males
  6. Poor dental hygiene
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8
Q

What are the complications of IE?

A
  1. HF
  2. End organ damge
  3. Neurological damge
  4. Metastatic infection
  5. Local tissue infammation
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9
Q

What are clinical presentation IE?

A
  1. Fever
  2. Roth spots
  3. Osler nodes
  4. Murmur
  5. Janeway lesions
  6. Anemia
  7. Nail bed hemorrhage
  8. Emboli
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10
Q

What are the complications of emboli?

A

Left sided EC -> renal artery emboli -> flank pain and hematuria -> splenomegaly -> infarction of spleen, brain stroke or meningitis
Right-sided -> pulmonary embolism and abscess

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11
Q

Wht is splinter hemorrhage?

A

Hemorrhages found on nail beds due to systemic depletion of fibrinogen and platelet

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12
Q

What are oosler nodes?

A

Purplish Papules or nodules on the toesdue to embolism, immunologic phenomena or both

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13
Q

What are Janeway lesions?

A

Painless hemorrhagic plaques on palms and soles due to embolism

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14
Q

What are roth spots?

A

Retinal infarct with central pallor and surrounding hemorrhages

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15
Q

What are the lab presentations of IE?

A

ECHO -> vegetation
Elevated WBC
Anemia/thrombocytopenia -> decreased fibrin
Increase ESR and CRP
Bacteremia

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16
Q

What are the diagnostic tools for IE?

A
  1. Blood cultures
  2. ECHO
  3. Duke criteria
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17
Q

What are the major Duke criteria?

A
  1. Positive blood culture in the absence of primary focus
    * Staph, strep, enterococcus, HACEK
    * Persistant positive blood cultures
  2. Evidence of endocardial
    * Vegetation +
    * New or worse murmur
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18
Q

What are the minor Duke criteria?

A
  1. Heart conditon or IVDU
  2. Fever
  3. Vascular phenomea (Janeway lesions, emboli)
  4. Immunologic phenomena (osler nodes, roth spots)
  5. Postive blood culture that is not major
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19
Q

What are categories of DUke criteria?

A

Definite: 2 major or 1 major+3 minor or 5 minor
Possible: 1 major+1 minor or 3-4 minor
Rejected: Not IE

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20
Q

Non pharm of IE?

A

Surgical repair of valves

21
Q

What is difference betwen acute and subacute?

A

Acute: sudden presentation of S. aureus
Subacute: graudually over weeks-monhs from Strep and preexisting vavular HD

22
Q

Valves affectedd by left and right IE?

A

Left: mitral/aortic
Right: tricuspid/pulmonary

23
Q

Difference between complicated and uncomplicated IE?

A

Com: right sided IE
Un: left-sided, MRSA

24
Q

What are the ideal properties of ABX for IE?

A
  1. High dose
  2. Prolonged activity
  3. Parenteral
  4. Bactericidal
25
When would you use empiric?
1. Confirmed IE and 2. Acutely ill or in HF Use narrow when results are available
26
Empiric therapy for native valves?
Pathogens: staph, strep, enterococcus, HACEK Vanc + Ceftriaxone or Gentamicin Alt: Dapt in place of Vanc
27
Empiric therapy for prosthetic valves?
Pathogens: S. aueurs + biofilm, strep, enterococci Vanc + Gentamicin + Rifampin
28
What is the purpose of using gentamicin in IE tx?
Provides G+ synergy coverage
29
Tx for staphy IE with MSSA
**Native:** Nafcillin or Oxacillin x 6b weeks **Prosthetic:** Nafcillin or Oxacillin + rifampin for 6 wk + gentamic synergy x 2 wks Alt: Cefazolin or vanc
30
Tx for staphy IE with MRSA
**NVE:** Vanco mono x 6 wks **PVE:** Vanc + rifampin x 6wk + Gentamic for first 2 wks Alt: Daptomycin x 6wks
31
Tx for Viridans IE with pen-susceptible strains
MIC ≤0.12 **Native:** Penicillin G x 4wk **PVE:** Penicillin G or Ceftriaxone + gentamic for 6 weeks Alt: Vancomicin (4wk for NVE, 6wk for PVE)
32
Tx for Viridans IE with intermediate pen-resistance strains
MIC 0.12-0.5 **NVE:** Penicillin for 4 wks + gentamycin firs 2 wks **PVE:** Pen G or ceftriaxone + Gentamicin fro 6 wks Alt: Vancomycin (4wk for NVE, 6wk for PVE)
33
Tx for Viridans IE with high pen-resistance strains
MIC >0.5 **NVE:** Pen G + gentamicin for 4-6wks **PVE:** Pen G or ceftriaxone + Gentamicin fro 6 wks Alt: Vancomycin (4wk for NVE, 6wk for PVE)
34
Tx for Enterococcus IE with pen and gen susceptible strains
E. facialis **NVE:** Ampicillin or Pen G + gent for 4-6 wks **PVE:** ampicillin + ceftriaxone for 6 wks **Alt:** Vanc + gent x 6 wks
35
Tx for Enterococcus IE with pen resistant strains
E. faecalis **NVE and PVE:** Vanc + gent x 6 wks **Alt:** Ampicillin-sulbactam + gent for 6 wks
36
Tx for Enterococcus IE with VRE strains
E. faecium **NVE, PVE, Alt:** Daptomycin or high-dose linezolid for 6 wks
37
Tx for HACEK IE
**NVE and PVE:** Ceftriaxone or ampicillin for 4 wks **Alt:** Ciprofloxacin, levofloxacin, moxifloxacin, ampicillin or ceftriaxone
38
Culture negative with native valve tx?
Vancomycin + cefepime Vancomycin + ampicillin/sulbactam 4-6wks
39
Culture negative with early (<1yr) prosthetic valve tx?
Vancomycin + cefipime + gent+ rifampin for 6 wks
40
Culture negative with late (>1yr) prosthetic valve tx?
Vancomycin + ceftriaxone for 6 wks
41
Who qualifies for OPAT?
1. hemodynamically stable 2. Competent of disease state 3. Has immediate access to medical care
42
What do you monitor for IE tx?
1. Hemodynamics 2. Blood cultures for bacteremia 3. TDM 4. CBC and serum 5. Drug tox and intolerance 6. New onset diarrhea -> C diff
43
How often do ou follow up for IE tx?
1. Follow vitals and lab QD till stable 2. Blood culture Q24-72H till negative 3. SS weekly 4. Daptomycin (hold statin) monitor CPK * follow up 1-3 months for 6 months
44
Who should get vaccines>
**NVE:** not recommend is successfully treated **PVE:** influenza, PPSV23 and 13, Tdap, Zoster
45
46
Who shold get IE prophylaxis?
People with dental problems Perforation/incision of oral mucosa or gingival tissue
47
PO prophylaxis tx?
Amoxicillin 2 g once Alt: cephalexine 2g once * Azithromycin or clarithromycin 500 mg once
48
NPO prophylaxis tx?
Ampicillin IV once Ceftriaxone IV once

Therapeutics IV (39 decks)

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