Endovascular infections

Question 1

Endocarditis:

Frequency of native valve, prosthetic valve and pacemaker associated

Answer 1

NV - 72%
PV - 21%
Pacemaker 7%

Question 2

Median age for IE

Answer 2

58 years old

Question 3

Estimated in-hospital mortality for IE

Answer 3

18%

Question 4

Diagnostic criteria for IE

Answer 4

Modified Dukes Criteria

Question 5

What percentage of people with IE have a negative echo?

What is the approach to reduce this number?

Answer 5

10-15% have a negative echo

Repeat echo in 7 to 10 days if clinical suspicion is high

Question 6

What echocardiographic features suggest IE?

Answer 6

Vegetations
Aortic root abscess
Acute MR

Question 7

What is the POET trial?
What were the findings?
What are some caveats to this?

Answer 7

partial oral vs IV Abx for treatment of IE
orals non-inferior to IVs
only small portion of those enrolled were randomised, most were likely fully treated with IVs before randomisation

Question 8

What defines uncomplicated MSSA/MRSA bacteraemia?

Answer 8

1. Exclusion of endocarditis
   
   2. No implanted prostheses (prosthetic valves, joint replacements etc)
   3. Follow up cultures taken at 2 to 4 days are negative
   4. Defervescence within 72 hours of therapy initiation
      No evidence of metastatic sites of infection

Question 9

What are the new recommendations for treatment of Enterococcus faecalis endocarditis?

Answer 9

Use amp or amox plus either gentamicin or ceftriaxone

Increasingly ceftriaxone is the synergistic agent of choice

Question 10

Common organisms for IE

Answer 10

Staphylococcus aureus (31%)
	Viridans group Streptococcus (17%)
	Coagulase negative Staphylococcus (11%)
	Enterococci (10%)
	Culture negative (10%)
** fungi / yeast 2%

Question 11

What percentage of global mortality is attributed to sepsis?

Answer 11

20%

Question 12

How much more likely are ATSI peoples to die from sepsis than non-ATSI people?

Answer 12

4x higher mortality

Question 13

What percentage have positive blood cultures in sepsis?

What percentage have no positive cultures at all in sepsis?

Answer 13

one third

one third

Question 14

What are the most common sources of sepsis?

Answer 14

Respiratory
Skin / soft tissue
intra-abdominal
Urinary tract

Question 15

What is the effect of delayed Abx administration?

Answer 15

increases mortality, magnitude varies depending on the study

Question 16

What are the 6 issues in sepsis / septic shock management guidelines?

Answer 16

1. haemodynamic management
2. antibiotics
3. steroids
4. ventillation
5. IVIG, Vitamin C
6. Source control

Question 17

What are the recommendations surrounding IV fluid resuscitation in sepsis?

Answer 17

30ml/kg of balanced crystalloid within first 3 hours

Question 18

Why is normal saline less favoured than hartmanns?

Answer 18

associated with:
hyperchloraemic metabolic acidosis
increased cytokine production
renal vasoconstriction and aki
increased mortality

Question 19

What is the target MAP when managing sepsis?

Answer 19

MAP of 65mmHg or greater

Question 20

What is the approach to vasopressors in sepsis / septic shock?

Answer 20

Use if not meeting MAP despite adequate fluid resuscitation
First line is noradrenaline
Consider adding vasopressin if MAP still <65mmHg despite low-to-moderate doses of norad

Question 21

What is the role of steroids in septic shock?

What dose is used?

Answer 21

Use if on vasopressors for at least 4 hours

Hydrocortisone 50mg IV Q4H

Question 22

What timing should Abx be administered within?

Answer 22

Depends if shock is present or not
If shock - less than 1 hour
If shock not present - less than 3 hours

Question 23

What are the HACEK organisms?

Answer 23

Haemophilus
Aggregatibacter
Cardiobacterium
Eikenella
Kingella

Question 24

What is the difference between microbiology in prosthetic valve IE?

Answer 24

early infection (<12 months) tends to be S. aureus or coagulase negative staph
late infection (>12 months) tends to be strep or enterococci