EXAM 4 infective endocarditis Flashcards
infective endocarditis
syndrome resulting in colonization or invasion of endocardium
risk factors: Prosthetic heart valve (highest risk)
Hx of endocarditis (highest risk)
causitive pathogens for endocarditis
Staph aureus (30-70%)
Streptococcus
Enterococci
laboratory findings for endocarditis
BLOOD CULTURES
draw 3 sets from different sites
Repeat labs (2 sets) every 48-72 hours
diagnosis requirements (Duke criter)
2 major or
1 major + 3 minor or
5 minor
Major criteria for endocarditis diagnosis
Positive blood culture (common organism isolated from 2+ culture, or rare organism from 3+ cultures)
Positive lab test
echocardiography or CT scan (vegetation/perforation/aneursym/fistula)
Proton emission with 18F showing abnormal activity
Surgical: evidence of IE by inspection
Minor criteria for endocarditis diagnosis
predisposition: previous IE, prosthetic valve, previous valve repair, CHD, cardiomyopathy, etc
clinical symptoms:
fever >38 C
vascular phenomena
immunologic phenomena
positive blood culture (not meeting critera)
imaging
physical exam (new valvular regurgitation
endocarditis treatment - viridans strep & s. gallolyticus
penicillin
ceftriaxone
vancomycin
endocarditis treatment - MSSA NATIVE
nafcillin/oxacillin
cefazolin if PCN allergy
endocarditis treatment - MRSA NATIVE
vancomycin
daptomycin
alternatices: ceftarroline or linezolid
endocarditis treatment - MSSA prosthetic
nafcillin/oxacillin
cefazolin if PCN allergy
+ rifampin
+ gentamicin
endocarditis treatment - MRSA prosthetic
vancomycin
+ rifampin
+ gentamicin
enterococci - penicillin/gentamicin susceptible
ampicillin + gentamicin
penicillin + gentamicin
Ampicillin + ceftriaxone ( if CrCl <50)
enterococci - penicillin susceptible & gentamicin resistant
ampicillin + ceftriaxone
enterococci - penicillin susceptible & gentamicin resistant & streptomycin susceptible
ampicillin/penicillin + streptomycin
enterococci - penicillin resistant/ b-lactamase producer/ cant take b-lactam/ vanc/gent susceptible
vancomycin + gentamicin
enterococci - penicillin/gentamicin/vancomycin resistant
daptomycin
linezolid
valve replacement may be necessary
HACEK (oral flora gram negative)
ceftriaxone –> preferred
ampicillin +/- sulbactam
ciprofloxacin
native: 4 weeks
prosthetic: 6 weeks
culture negative endocarditis - native valve
acute onset: vancomycin + cefepime
subacute onset: vancomycin + unasyn
culture negative endocarditis - prosthetic valve <1 year
vancomycin + cefepime + gentamicin + rifampin
culture negative endocarditis - prosthetic valve >1 year
vancomycin + ceftriaxone
culture negative endocarditis - suspected bartonella
ceftriaxone + gentamicin +/- doxycycline
culture negative endocarditis - suspected bartonella
gentamicin + doxycycline
