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D&D Infectious Disease Midterm > Endocarditis Part 1 > Flashcards

Endocarditis Part 1 Flashcards

1
Q

infective endocarditis is commonly referred to as….

A

an infection of the heart valves by various microorganisms after they enter the bloodstream

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2
Q

infective endocarditis is an infection of the heart valves after entry of microorganisms into where?

A

the bloodstream

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3
Q

define bacteremia

A

presence of bacteria in the bloodstream

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4
Q

infective endocarditis is an inflammation of what?

A

the endocardium (the membrane lining the chamber of the heart and the cusps of the heart valves)

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5
Q

TRUE OR FALSE

endocarditis is associated with high rates of morbidity and mortalitiy

A

true

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6
Q

name some high risk populations for infective endocarditis

A

IV drug users
prosthetic valves
congenital heart disease
men more than women
older pts over 60

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7
Q

which bacteria is associated with acute endocarditis? what about subacute?

A

acute - staph aureus

subacute - strep viridians

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8
Q

most patients with ______ infective endocarditis have a preexisting valvular heart disease

A

subacute

have prsthetic valves or cardiac devices too

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9
Q

indolent vs fulminating

which is acute infective endocarditis vs subacute

A

indolent (happens over period of time) = subacute

fulminating (happens suddenly) = acute

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10
Q

TRUE OR FALSE

death occurs within days-weeks for acute infective endocarditis

A

true

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11
Q

for which may the patient have high fevers, WBC and may even be septic and associated with systemic toxicities — acute or subacute infective endocarditis

A

acute

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12
Q

2 of the HIGHEST risk factors for infective endocarditis

A

presence of a prosthetic valve
previous endocarditis

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13
Q

true or false

poor dentition and poor oral hygiene are not a risk factor for infective endocarditis

A

FALSE - THEY ARE

bc there’s a LOT of bacteria in the oral flora. a cut in the mouth can easily introduce these bacteria into the bloodstream and then potentially the heart

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14
Q

3 main “bugs” that cause infective endocarditis

A

staphylococci (MOST is staph aureus)
streptococci
enterococci

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15
Q

staphylococci are the main “bugs” responsible for infective endocarditis

break this down further

A

most is coagulase positive (staph aureus) but some is also coagulase negative (staph epidermidis)

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16
Q

streptococci are 1 of the 3 main “bugs” that cause infective endocarditis

name specific subclass of streptococci that is common

A

strep viridians

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17
Q

true or false

staph, strep, and enterococci are all gram (+)

A

TRUE

therefore, most of the time a gram positive organism is causing IE, but it’s still possible it could be gram (-) (healthcare exposure) or be a fungi, or polymicrobial

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18
Q

is it possible for the cultures to be negative but there’s still a case of infective endocarditis?

A

YES

we can’t isolate the organism but everything else is matching to IE

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19
Q

which 3 valves can be affected by infective endocarditis and for which is it the most common

which is most commonly infected in IV drug users

A

mitral valve (most common)
aortic valve
tricuspid valve (IV drug users)

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20
Q

true or false

a vegetation can form in any heart valve

A

TRUE

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21
Q

2 SPECIFIC clinical presentation features of infective endocarditis

HALLMARK OF IE - LAB FINDING

A

fever and heart murmurs

lab finding - continuous bacteremia

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22
Q

in general, IE should be suspected in any patient who has……

A

-documented fever + heart murmur

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23
Q

some peripheral manifestations of infective endocarditis

A

Osler’s nodes
Janeway’s lesions
Roth’s spots
clubbing of the fingers
emboli
splinter hemorrhages

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24
Q

osler node vs janeway lesion

A

osler’s nodes are painful and theyre on the pads of the fingers and toes

janeway lesions are PAINLESS plaques on the palms of hands or soles of the feet

both are the result of embolism

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25
Q

explain what roth spots are

A

retinal infarcts that are the result of infective endocarditis

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26
Q

what are splinter hemorrhages

A

peripheral manifestation of IE

on the nails

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27
Q

clubbing of the nails is typically observed in what endocarditis

A

long-standing

28
Q

a nonspecific lab finding in infective endocarditis will be leukocytosis with ______ shift

A

left

29
Q

differentiate between the 2 echocardiograms

A

TTE (transthoracic echo) is less sensitive (high chance of false negatives - may not catch all cases) but it’s easy to do at bedside and you don’t have to fast

TEE (transesophageal echo) has a HIGHER sensitivity (better at finding IE) but you have to fast and it’s more expensive and invasive

30
Q

what is the “diagnostic tool” for infective endocarditis

A

the modified duke criteria

combines clinical findings, lab findings, and echo findings

31
Q

according to modified duke criteria, 2 major criteria is considered…

A

DEFINITE IE

32
Q

1 major + 1 minor criteria is considered…..

A

possible IE

33
Q

3 minor criteria is considered….

A

possible IE

34
Q

5 minor criteria is considered…..

A

definite IE

35
Q

name 3 MAJOR criteria

A

-blood culture positive for IE
-echocardiogram positive for IE
-new valvular regurgitation

36
Q

goals of therapy to treat infective endocarditis

A

-relieve signs and symptoms
-decrease morbidity and mortality
-eradicate bacteria
-give appropriate antimicrobial therapy
-prevent from reoccuring in certain high risk patients (antimicrobial prophylaxis)

37
Q

true or false

managing infective endocarditis is not a team approach

A

FALSE – it is
involves cardiologists, cardiac surgeons, and specialists in infectious disease

38
Q

explain the type of antibiotics given in infective endocarditis (ie - dose, route, length of time)

A

HIGH DOSE parenteral (IV) bactericidal

given for MINIMUM 4-6 weeks (prolonged duration)

39
Q

surgery in endocarditis is performed often or no?

A

in around 50% of patients to remove the vegeation

they can get the valve removed and replaced

40
Q

3 indications for surgery in an endocarditis patient

A

heart failure
large vegetations
persistent bacteremia and antibiotics aren’t working

41
Q

name 2 subgroups of streptococci that cause endocarditis

are they part of normal flora?

A

streptococci viridans (normal flora of the mouth and gingiva)

streptococcal gallolyticus (normal flora of the gut)

42
Q

streptococcal species are a common cause of endocarditis involving native valves or prosthetic valves?

A

native valves

43
Q

usually, infective endocarditis caused by streptococcal species is acute or subacute?
what does this say about the cure rate?

A

subacute

very high cure rate - 95%

44
Q

which streptococcal species is associated with GI pathology, especially colon carcinoma

A

streptococcus gallolyticus – normal flora of the gut

non-enterococcal Group D strep

45
Q

patient has native valve endocarditis from streptococcal species

name 5 therapy options, assuming the species is HIGHLY SUSCEPTIBLE to penicillin

A

Penicillin G IV for 4 weeks
Ceftriaxone IV for 4 weeks

Penicillin G IV + Gentamicin IV for 2 weeks
Ceftriaxone IV + Gentamicin IV for 2 weeks
THIS 2 WEEK REGIMEN IS NOT FOR EVERYONE

Vancomycin IV for 4 weeks
ONLY IF UNABLE TO TOLERATE PENICILLIN OR CEFTRIAXONE

46
Q

as mentioned, the 2 week regimen for streptococcal native valve endocarditis is not for everyone

name 5 pt profiles in which this 2 week therapy is not recommended

A

over 65

children

impairment of 8th cranial nerve

creatinine clearance less than 20 mL/min

cardiac or extracardiac ascess

47
Q

what is target AUC for vanco?
what is target trough?

A

AUC - 400-600
trough 15-20mcg/mL

48
Q

why is gentamicin combined with penicillin G/ceftriaxone in some scenarios

A

for SYNERGY
gives more rapid killing

49
Q

patient has native valve endocarditis from streptococcal species

what are potential antimicrobial agents, if the sample is relatively resistant to penicillin??

what about resistant?

A

relatively resistant:

Pen G (4 weeks) + gentamicin IV (for initial 2/4 weeks)

ceftriaxone (4 weeks) + gentamicin IV (for initial 2/4 weeks)

or vanco IV for 4 weeks (only if unable to tolerate pen or ceftriaxone)

IF RESISTANT - FOLLOW TREATMENT FOR ENTEROCOCCAL ENDOCARDITIS

50
Q

Target gentamicin trough and peak

A

trough less than 1 mcg/mL (otherwise - toxicity)

peak of 3-4 mcg/mL - shows efficacy

51
Q

Pt has PROSTHETIC valve endocarditis caused by streptococcal species

what are potential therapies assuming highly susceptible to penicillin

A

Penicillin G IV 6 weeks
Ceftriaxone IV 6 weeks
Vancomycin IV 6 weeks (if can’t tolerate pen or ceftriaxone)

52
Q

Pt has PROSTHETIC valve endocarditis

what are potential therapies assuming relatively resistant to penicillin?? what about resistant?

A

relatively resistant:

Pen G + Gentamicin IV ALL for FULL 6 WEEKS

ceftriaxone IV + Gnetamicin IV ALL FOR FULL 6 WEEKS

OR

Vancomycin IV for 6 weeks (if can’t tolerate pen or cef)

if resistant, follow treatment for enterococcal endocarditis

53
Q

*pt is 72 with streptococcal endocarditis on native heart valve.
MIC < 0.12mcg/mL

NKA
what regimen is appropriate

A

MIC < 0.12mcg/mL means highly susceptible to penicillin

Ceftriaxone IV for 4 weeks or Penicillin G IV for 4 weeks

NO REASON TO GIVE VANCO AND NOT INDICATED FOR 2 WEEK THERAPY WITH GENTAMICIN

54
Q

pt is 50 with streptococcal endocarditis on a PROSTHETIC heart valve.
MIC less than 0.12mcg/mL

NKA and good renal function

what is appropriate regimen

A

Penicillin G IV for 6 Weeks OR Ceftriaxone IV for 6 weeks

NO INDICATION FOR VANCO AND DON’T ADD GENTAMICIN UNTIL RELATIVELY RESISTANT

55
Q

*Pt is 42 with streptococcal endocarditis on a native valve

MIC is 1 mcg/mL

NKA

what regimen is appropriate

A

MIC 1mcg/mL means relatively resistant

give Penicillin IV (or ceftriaxone IV) for 4 weeks and gentamicin IV for the initial 2 weeks

56
Q

Pt is 42 with streptococcal endocarditis on a prosthetic heart valve

MIC is 1mcg/mL

NKA

what regimen is appropriate

A

Penicillin G/ceftriaxone IV + gentamicin IV for FULL 6 WEEKS

57
Q

Which bacteria that causes endocarditis is most common among IV drug abusers, those with venous catheters, and valve replacement surgery?

A

STAPH AUREUS

58
Q

What MIC is considered relatively resistant to penicillin vs resistant to penicillin

A

relatively resistant: MIC >0.12-5mcg/mL

resistant: >5mcg/mL

59
Q

________- are common causes of PROSTHETIC valve endocarditis

A

staph epidermidis (coagulase negative) and staph aureus (coagulase positive)

60
Q

coagulase negative staph

A

staph epidermidis

61
Q

ALL ________ BACTEREMIA SHOULD BE SCREENED FOR ENDOCARDITIS

A

staph aureus

62
Q

which bacteria “loves” prosthetic devices and clumps together on them to form a biofilm?

A

staph

63
Q

pt has native valve endocarditis caused by STAPHYLOCOCCI

what is therapy and length if MRSA vs MSSA

A

MSSA - nafcillin or oxacillin IV for 6 weeks

MRSA - vancomycin IV for 6 weeks

64
Q

as mentioned, for native valve IV caused by MSSA staph, 1ST LINE IS NAFCILLIN OR OXACILLIN IV FOR 6 WEEKS

what if they are allergic to penicillin?

A

if NON anaphylactic reaction – can give cefazolin (1st gen)

if anaphylactic reaction to penicillin - use vancomycin

65
Q

as mentioned, for native valve IE caused by MRSA staph, 1st line is vancomycin IV for 6 weeks

what if the patient can’t tolerate vanco?

A

can use daptomycin (preferred bc FDA approved) or linezolid

66
Q
A

D&D Infectious Disease Midterm (26 decks)

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