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Infectious Disease > Endovascular Infections > Flashcards

Endovascular Infections Flashcards

1
Q

What are the Class I indications for TEE in the work up of infective endocarditis?

A
  1. TTE Non-diagnostic
  2. IE complications suspected
  3. Intracardiac lead present
  4. In patients being considered for any early change to oral abx therapy (baseline TEE with repeat 1-3 days prior to completing abx)
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2
Q

What are the HACEK organisms?

A 
Hemophilus
Aggregatibacter
Cardiobacterium
Eikenella
Kingella
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3
Q

What are the major criteria for infective endocarditis?

A
  1. Microbiological Evidence

2. Endocardial Involvement

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4
Q

What are the microbiological major modified Duke criteria for IE?

A
  1. Typical organisms: S. aureus, viridans groups strep, S. gallolyticus, enterococcus, HACEK in 2 cultures > 12 hours apart or > or = 3 cultures > 1 hour apart.
    OR
  2. 1 blood culture demonstrating Coxiella
    OR 3. Coxiella anti-phase 1 IgG > or = 1:800
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5
Q

What are the modified Duke criteria for endocardial involvement?

A
  1. Oscillating valvular/prosthetic mass
  2. Valvular abscess
  3. Dehiscence of prosthetic valve
  4. New valvular regurgitation
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6
Q

What are the minor modified Duke criteria?

A
  1. Predisposition
  2. Fever > 38 C
  3. Vascular Phenomenon
  4. Immunological Phenomenon
  5. Microbiological evidence (+ blood culture not meeting a major criterion)
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7
Q

What are the predisposing features included in the minor criterion of the Duke criteria?

A

Heart defect
Prosthetic valve
IVDU

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8
Q

What are the vascular phenomenon of the modified Duke criteria (6)?

A 
Arterial emboli
Septic pulmonary infarcts
Mycotic aneurysm
IC hemorrhage
Conjunctival hemorrhage
Janeway lesions
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9
Q

What are the immunological criteria of the modified Duke criteria (4)?

A

Glomerulonephritis
Osler nodes
Roth spots
+ Rheumatoid factor

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10
Q

What are the modified Duke criteria requirements for definitive and possible IE?

A

Definite:

  • Positive vegetation culture or histopathology
  • 2 major criteria OR 1 major and 3 minor OR 5 minor criteria

Possible:
1 major + 3 minor OR 3 minor

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11
Q

What is the treatment for MSSA prosthetic valve endocarditis?

A

Cloxacillin OR cefazolin
PLUS:
Rifampin & Gentamycin

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12
Q

How is a HACEK group endocarditis treated?

A

Ceftriaxone

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13
Q

How is an MRSA or CNST native valve IE treated? What about prosthetic valve?

A

Native Valve: Vancomycin

Prosthetic Valve: Vancomycin + rifampin + gentamycin

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14
Q

How is Enterococcus faecalis endocarditis treated?

A

Ampicillin PLUS:

Gentamycin OR ceftriaxone

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15
Q

How is Enterococcus faecium IE treated?

A

Vancomycin + Gentamycin

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16
Q

What is the duration of treatment for IE?

A

4-6 weeks

Longer for increasing beta-lactam resistance, S. aureus and prosthetic valves.

17
Q

In which patients can you consider step down to oral therapy for treatment of infective endocarditis?

A

In patients with left-sided IE caused by Streptococcus, E. faecalis, S. aureus or CNST deemed stable by a multidisciplinary team.

MUST receive a TEE before switching AND be able to have frequent/appropriate follow up AND a follow up TEE needs to be done 1-3 days before d/c antibiotic therapy.

18
Q

What are the Class I indications for “early surgical intervention” in infective endocarditis (5)?

A
  1. Valve dysfunction with signs or symptoms of heart failure despite optimal medical therapy.
  2. Left-sided IE caused by S. aureus, fungi or highly resistant organisms.
  3. Heart block, annular/aortic root abscess, destructive penetrating lesions.
  4. Persistent bacteremia or fever > 5 d after starting appropriate abx.
  5. Complete removal of implantable electronic cardiac device systems with definite endocarditis.
19
Q

What are the Class I indications for delayed surgery in infective endocarditis (2)?

A
  1. Prosthetic Valves: relapsing infection (new fevers, bacteremia after a complete course of appropriate abx and interval sterile blood culture, without other source/portal for infection).
  2. In patients with recurrent endocarditis in the setting of continued IVDU, consultation w/addiction medicine is recommended before repeat surgical intervention is considered.
20
Q

What are the Class II EARLY surgical indications for infective endocarditis?

A
  1. Reasonable in those with recurrent a boil and persistent vegetation’s despite an appropriate course of antimicrobial therapy.
  2. In those with native L-sided valvular endocarditis with mobile vegetation > 10 mm with or without emboli phenomenon, especially when anterior MV leaflet.
  3. For patients who have had a minor emboli stroke (no extensive deficits) without ICH in patients with an indication for iE surgery.
21
Q

What is the Class II indication for delayed surgery (> 4 weeks) in infective endocarditis?

A

In patients who are hemodynamically stable after a major ischemic or hemorrhagic stroke.

22
Q

Which are the patients that need infective endocarditis prophylaxis in the setting of specific procedures?

A
  1. Prosthetic Cardiac Valves (including TAVI)
  2. Prosthetic Cardiac Material (annuloplasty ring, chord, clips)
  3. Previous IE
  4. Congenital HD if:
    - cyanotic heart disease, un-repaired
    - CHD post-repair within 6 months
    - CHD post-repair with residual defect
  5. Cardiac Transplant Recipients with valve regurgitation attributable to structurally abnormal valve.
23
Q

In what types of procedures is prophylaxis required for infective endocarditis?

A
  1. Dental procedures involving gingival manipulation, manipulation of the peri-apical tissue and perforation of oral mucosa.
  2. Respiratory tract procedures with transaction of respiratory mucosa, such as tonsillectomy, adenoidectomy

NOT FOR GU/GI, Gyne

24
Q

What are the guidelines for duration of secondary prophylaxis in patients with history of rheumatic fever?

A
  1. RF w/carditis & residual valvular disease - 10 years or until patient is 40 (whichever later)
  2. RF w/carditis w/o residual VHD - 10 years or until 21 (whichever longer)
  3. RF w/o carditis - 5 years or until 12 (whichever is longer)
25
Q

What are the possible regimens for IE prophylaxis?

A

Amoxicillin 2g PO x 1 OR ampicillin 2g IV/IM OR cefazolin/CTX 1 g IV/IM

If Pen allergy:
Cephalexin 2 g PO OR clindamycin 600 mg PO/IM/IV OR azithromycin 500 mg PO OR cefazolin/CTX 1g IV/IM

26
Q

When do you give IE prophylaxis (timing) prior to a procedure?

A

Within 30-60 minutes

27
Q

How would you treat Lyme disease with cardiac involvement?

A

Ceftriaxone 14-21 days

Infectious Disease (13 decks)

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