Infective Endocarditis

Question 1

Risk factors for infective endocarditis

Answer 1

congenital heart disease, prolonged vascular access, IV drug use, prosthetic material, valve dysfunction, increased age

Question 2

Pathogens that cause IE

Answer 2

Staph aureus, streptococcus, enterococcus

Question 3

Clinical presentation of IE

Answer 3

Fever, chills, weakness, weight loss, malaise, heart murmurs, sepsis symptoms, splenomegaly, Osler’s nodes, Janeway’s lesions, petechiae, Roth’s spots, septic emboli

Question 4

Diagnosis of IE

Answer 4

Positive blood culture and echocardiogram

Question 5

Diagnosis with TTE and/or TEE

Answer 5

Low risk: TTE

High risk: TTE followed by TEE

Question 6

Treatment of IE: streptococcus, Pen G MIC is ≤0.12 mcg/ml and is a native valve

Answer 6

Pen G 12-18 million units for 4 weeks

Pen G 12-18 million units for 2 weeks plus gentamicin 3mg/kg daily

Ceftriaxone 2g QD x4 weeks

Ceftriaxone 2g QD x2 weeks plus gentamicin 3mg/kg daily

Question 7

Treatment of IE: streptococcus, Pen G MIC is >0.12mcg/ml and is a native valve

Answer 7

Pen G 24 million units daily x4 weeks and gentamicin 3mg/kg daily x2 weeks

Ceftriaxone 2g QD x4 weeks

Question 8

Treatment of IE: MSSA and is a native valve

Answer 8

Nafcillin 12g/day in divided doses x6 weeks

Question 9

Treatment of IE: MRSA and is a native valve

Answer 9

Vanco x6 weeks

Question 10

Treatment of IE: MRSA and is a prosthetic valve

Answer 10

Vanco and rifampin 900mg/day x6 weeks plus gentamicin 3mg/kg/24h x2 weeks

Question 11

Treatment of IE: MSSA and is a prosthetic valve

Answer 11

Nafcillin and rifampin 900mg/day x6 weeks plus gentamicin 3mg/kg/day x2 weeks

Question 12

Treatment of IE: PCN-susceptible enterococcus

Answer 12

Ampicillin 2g q4h and ceftriaxone 2g q12h x6 weeks