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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
Q

When would you use empiric?

A
  1. Confirmed IE and
  2. Acutely ill or in HF

Use narrow when results are available

26
Q

Empiric therapy for native valves?

A

Pathogens: staph, strep, enterococcus, HACEK

Vanc + Ceftriaxone or Gentamicin
Alt: Dapt in place of Vanc

27
Q

Empiric therapy for prosthetic valves?

A

Pathogens: S. aueurs + biofilm, strep, enterococci

Vanc + Gentamicin + Rifampin

28
Q

What is the purpose of using gentamicin in IE tx?

A

Provides G+ synergy coverage

29
Q

Tx for staphy IE with MSSA

A

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
Q

Tx for staphy IE with MRSA

A

NVE: Vanco mono x 6 wks
PVE: Vanc + rifampin x 6wk + Gentamic for first 2 wks

Alt: Daptomycin x 6wks

31
Q

Tx for Viridans IE with pen-susceptible strains

A

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
Q

Tx for Viridans IE with intermediate pen-resistance strains

A

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
Q

Tx for Viridans IE with high pen-resistance strains

A

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
Q

Tx for Enterococcus IE with pen and gen susceptible strains

A

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
Q

Tx for Enterococcus IE with pen resistant strains

A

E. faecalis
NVE and PVE: Vanc + gent x 6 wks
Alt: Ampicillin-sulbactam + gent for 6 wks

36
Q

Tx for Enterococcus IE with VRE strains

A

E. faecium
NVE, PVE, Alt: Daptomycin or high-dose linezolid for 6 wks

37
Q

Tx for HACEK IE

A

NVE and PVE: Ceftriaxone or ampicillin for 4 wks
Alt: Ciprofloxacin, levofloxacin, moxifloxacin, ampicillin or ceftriaxone

38
Q

Culture negative with native valve tx?

A

Vancomycin + cefepime
Vancomycin + ampicillin/sulbactam

4-6wks

39
Q

Culture negative with early (<1yr) prosthetic valve tx?

A

Vancomycin + cefipime + gent+ rifampin for 6 wks

40
Q

Culture negative with late (>1yr) prosthetic valve tx?

A

Vancomycin + ceftriaxone for 6 wks

41
Q

Who qualifies for OPAT?

A
  1. hemodynamically stable
  2. Competent of disease state
  3. Has immediate access to medical care
42
Q

What do you monitor for IE tx?

A
  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
Q

How often do ou follow up for IE tx?

A
  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
Q

Who should get vaccines>

A

NVE: not recommend is successfully treated
PVE: influenza, PPSV23 and 13, Tdap, Zoster

45
Q
A
46
Q

Who shold get IE prophylaxis?

A

People with dental problems
Perforation/incision of oral mucosa or gingival tissue

47
Q

PO prophylaxis tx?

A

Amoxicillin 2 g once
Alt: cephalexine 2g once
* Azithromycin or clarithromycin 500 mg once

48
Q

NPO prophylaxis tx?

A

Ampicillin IV once
Ceftriaxone IV once

Therapeutics IV (39 decks)

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