endocarditis therapeutics

Question 1

pathophysiology of endocarditis

Answer 1

• previously damaged heart valve
• platelet-fibrin deposition creating thrombosis
• bacteremia
• bacterial adherence to thrombus

Question 2

procedures associated with bacteremia

Answer 2

• dental extraction
• tonsillectomy
• cystoscopy
• tooth brushing/flossing

Question 3

most common bacteria in endocarditis

Answer 3

staph

strep

Question 4

clinical presentations of endocarditis

Answer 4

• fever
• cough
• dyspnea
• anorexia
• weight loss
• night sweats
• fatigue
• splenomegaly
• back pain

Question 5

less common presentations of endocarditis

Answer 5

• clubbing fingertips
• splinter hemorrhages
• retinal eye lesions

Question 6

uncommon presentations of endocarditis

Answer 6

• osler’s nodes (painful)

- janeway lesions (nontender)

Question 7

symptoms of right heart failure

Answer 7

• nausea, abdominal pain
• peripheral edema
• hepatojugular reflux
• JVD
• hepatomegaly
• anorexia
• constipation

Question 8

symptoms of left heart failure

Answer 8

• dyspnea
• nocturnal dyspnea
• othopnea
• tachypnea
• hemoptysis
• pulmonary edema
• S3 gallop

Question 9

endocardiditis workup plan

Answer 9

• identify Sx including CHF
• 3 consecutive blood cultures for >90% (draw 1st & 3rd at least 1 hours apart)
• venopuncture 1 culture = 2 bottles (aerobe and anaerobe)
• echocardiogram
• chest x-ray

Question 10

antibiotics for native valve S.viridans

Answer 10

PCN
ceftriazone
vancomycin

Question 11

antibiotics for enterococcus in endocarditis

Answer 11

-linezolid
-daptomycin
for over 6 weeks

Question 12

antibiotics for native valve MSSA

Answer 12

nafcillin

cefazolin

Question 13

antibiotics for native valve MRSA

Answer 13

vancomycin

daptomycin

Question 14

empiric antibiotics for prosthetic valve when IE develops <2 months after placed

Answer 14

vanco +

• gent
• rifampin

Question 15

empiric antibiotics for prosthetic valve when IE develops >2 after placed

Answer 15

vanco +

• gent
• rifampin

Question 16

antibiotics for prosthetic valve w/ PCN susceptible if MIC < 0.12 viridans strep and S.gallolyticus

Answer 16

-PCN g x6wk
-ceftriaxone x6wk
-ampicillin x6wk
+/- gentamycin x2wk
-vancomycin x6wk

Question 17

antibiotics for prosthetic valve w/ PCN resistance or MIC >0.12 in viridans strep and S.gallolyticus

Answer 17

• PCN G +gent
• ceftriaxone +gent
• vancomycin

Question 18

antibiotics for prosthetic valve MSSA infection

Answer 18

nafcillin +

• rifampin TID
• gentamicin

Question 19

antibiotics for prosthetic valve MRSA infection

Answer 19

• vanco+rifampin+gent
• vanco
• rifampin
• gent

Question 20

HACEK IE features

Answer 20

• slow growers over 2-3 weeks (cultures needs lots of time)

- large friable vegetaitons

Question 21

antibiotics for HACEK in native or prosthetic valves

Answer 21

ceftriaxone first

• native = 4 weeks
• prosthetic = 6 weeks
• other options after C&S amp/sulbac or cipro

Question 22

complication of IE

Answer 22

CHF

Question 23

prophylaxis of IE is recommended for

Answer 23

-patients with prior outlined condition
AND
-who undergo procedures likely to enhance bacteremia

Question 24

conditions that prophylaxis are recommended for

Answer 24

• prosthetic valves or valve repair
• prior IE
• congenital heart disease
• heart transplant w/ regurgitation

Question 25

procedures that prophylaxis is recommended for

Answer 25

• dental procedures involving gingival tissue
• periapical region of teeth
• perforation of oral mucosa

Question 26

antibiotics for dental prophylaxis

Answer 26

• amoxicillin 2g
• ampicillin 2g
• clindamycin 600 mg
• azithromycin 500 mg
• clarithromycin 500 mg
• cephalexin 2g
• clindamycin 600 mg
• cefazolin 1g