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Host and Defense > EXAM 1 Intravascular Infections > Flashcards

EXAM 1 Intravascular Infections Flashcards

1
Q

what is bacteremia?

A

the presence of bacteria in the blood stream

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2
Q

describe how bacteremia can be transient

A
  • clearance exceeds entry
  • source is local infection somewhere
    • skin, lungs, bone, joint, abdomen
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3
Q

describe how bacteremia can be continuous

A
  • seeding exceeds clearance capacity
    • endovascular infections
  • septicemia (sepsis syndrome)
    • resists clearance mechanisms (virulence)
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4
Q

what are some examples of endovascular infections?

A
  • infective endocarditis
  • infected thrombus (blood clots)
    • septic thrombophlebitis
  • mycotic aneurysm
    • arterial wall infection
  • infections of intravascular devices
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5
Q

describe some examples of inftavascular devices that can cause endovascular infections

A
  • catheters
  • pacemaker and defibrillator wires
  • left ventricular assist devices (LVADs)
  • arterial conduits
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6
Q

describe blood cultures

A
  • blood removed aseptically
  • dilution of blood sample into broth
  • the special case of IE - timing
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7
Q

describe the sensitivity and specificity of blood cultures

A
  • sensitivity
    • important variable is volume
    • the larger the sample, the more sensitive
  • specificity
    • false positivity rate varies
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8
Q

what are risk factors for the predisposition of endocarditis?

A
  • congenital heart disease
  • rheumatic heart disease
  • conditions leading to bacteremia
    • dental, urological, gastrointestinal
  • intravenous drug abuse
  • hospitalization
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9
Q

T or F

survival rates for endocarditis during pre-antibiotic era was 0%, with all dead within one year

A

true

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10
Q

describe the pathogenesis of endocarditis

A
  • turbulent blood flow
    • brings about endothelial cell activation
    • body reacts by clotting
    • fibrin and platelet distribution
  • silent or clinical bacteremia seed sterile vegetations
  • bacteria grow within fibrin vegetations
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11
Q

what are the host defenses for endocarditis?

A
  • endocardium including valves, chordae, papillary muscle attachments, and atria receive their nourishment from the blood stream
  • therefore, endocardium lacks capillary circulation required for neutrophil access to the site of infection
  • thus, the innate and acquired immune mechanisms are subverted
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12
Q

given that the endocardium lacks capillary circulation, what happens to bacteria embedded within vegetations?

A

the bacteria is impossible to entire eradicate

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13
Q

infective endocarditis is characterized by ___ within vegetaitons leading to ___

A
  • unrestricted microbial replication
  • in vivo bacterial colonies
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14
Q

describe the two major criteria for infective endocarditis diagnosis

A
  • continuous bacteremia
  • target lesion on valve, supports, or endocardium (by ECHO or new murmur)
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15
Q

describe the 5 minor criteria for the diagnosis of infective endocarditis

A
  • fever
  • predisposing heart condition
  • injection drug use
  • embolic phenomena
  • immunological phenomena
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16
Q

describe the microbiology of infective endocarditis

A
  • staphylococci
    • s. aureus
    • coagulase-negative staphylococci sp.
  • streptococci
    • viridans species and gamma strep sp.
  • enterococci
  • gram negative bacilli
    • HACEK
    • enteric bacilli (IVDA)
  • fungi (candida sp.)
  • many others
  • culture negative IE
17
Q

what are some complications that arise form infective endocarditis?

A
  • congestive heart failure
  • stroke
  • infarcts
  • glomerulonephritis
  • mycotic aneuysms
  • abscesses
    • local (myocardium)
    • distant (embolic seeding)
18
Q

what is the incidence of bacteremia after periodontal surgery?

A

60-90%

19
Q

what is the incidenc eof bacteremia after tooth extraction?

A

18-85%

20
Q

what is the incidence of bacteremia after brushing or oral irrigation device?

A

7-50%

21
Q

what is the incidence of bacteremia after tonsillectomy?

A

33-38%

22
Q

what are the high risk outcomes from infective endocarditis?

A
  • prosthetic heart valves or prosthetic material inserted for cardiac valve repair
  • previous infective endocarditis
  • congenital heart disease
  • cardiac transplant patients who develop valvulopathy
23
Q

describe the prevention of infective endocarditis

A
  • prophylactic antibiotics prior to procedures
    • prosthetic heart valves
    • previous infective endocarditis
    • congenital heart diseases
    • heart transplant with valvulopathies
  • IV or PO regimens at time of procedures
24
Q

describe the treatment of infective endocarditis

A
  • cure depends upon treatment
    • IV therapy (no pills)
    • bactericidal regimen
    • length of treatment - 2, 4, 6, 8 weeks
    • special tests for antibiotic sensitivity
  • surgery
  • AHA treatment guidelines

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