infective endocarditis Flashcards

1
Q

how may a patient develop a septic shock?

A
  • where there is bacteria in the blood stream

- life-threatening

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2
Q

what questions should you ask about positive cultures?

A
  1. what is the habitat of this organism
  2. what diseases is this organism associated with?
  3. what is the optimum antimicrobial management required?
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3
Q

what kinds of organisms are found on the skin from cardiac implantable electronic devices?

A
  • staphylococcus aureus
  • staphylococcus epidermidis
  • corynebacterium sp.
  • propionibacterium acnes
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4
Q

what are the risk factors for ICED infections?

A
  • no pre preocedure prophylaxis
  • complexity of procedure
  • temporary paper use
  • type of device
    number of revisions/ reinterventions
  • fever within 24 hours
  • heart failure, renal failure
  • haematoma post procedure
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5
Q

what is generator pocket infection?

A
  • localised cellulitis
  • pain
  • swelling
  • discharge
  • wound breakdown
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6
Q

when should blood cultures be taken?

A
  • prior to starting antimicrobial therapy
  • wait 1 hour before giving antibiotics if they have septic shock, wait longer if not
  • take good quality samples
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7
Q

what is endocarditis?

A
  • infectoin of endothelium of heart valves
  • left threatnenin - often diagnosed late
  • up to 25% mortality
  • may be acute or subacute
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8
Q

what is the epidemiology of endocarditis?

A
  • 1/1000 hospital admissions
  • increasing mean age >50 years
  • hospital-aquired cases increasng, due to staph aureus
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9
Q

what are the predisposing factors of infective endocarditis?

A
  • heart valve abnoramlity
  • calcificaiton in elderly
  • CongenitalHD
  • post rheumatic fever
  • prosthertic heart valve
  • IV drug users
  • intravascular lines
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10
Q

what is the pathogenesis of endocarditis?

A
  • heart valve damaged
  • turbulent blood flow over roughened endothelium
  • patelets/ fibrin deposited
  • bacteraemia (may be transient) eg from dental treatment organisms settle in fibrin/platelet thrombi becoming a microbial vegetation
  • infected vegetations are fribale and break off, becoming lodged in the next capillary bed they encounter causing absesses or haemorrhage - may be fatal
  • usual left side of heart affected (mitral and aortic valve)
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11
Q

what are the main organisms cauing endocarditis native valve?

A
  • staph aureus
  • viridnas group streptococci
  • enterococcus sp
  • staph epidermis
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12
Q

what are the unusual organisms endocarditis?

A
  • atypical organisms = bartonella, coxiella burnetii (Q-fever), chlamydia, legionella, mycoplasma, brucella
  • gram negatives = HACEK organisms = haemophilus spp, aggregatibacter soo, cardiobacterium, eikenella sp, kingella sp
  • NON HACKET gram negatives = fungi
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13
Q

when would you look up DUKES criteria?

A
  • if you think there is endocarditits,
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14
Q

when would a blood cultures be positive for IE?

A
  • detection of endocarditits-specific pathogens in 2 independant blood cultures: viridans streptococci, streptococcus gallolyticus (bovis), HACEK group, staohylococcus aureus or community -aquired enterococci without evidence of primary focus
  • or microorganisms compatibla with an IC in peristsanely positive blood cultures: at least 2 positive blood cultures from blood withdrawals at least 12 hours apart or each or 3 of a pluarity of > 4 separate blood cultures
  • or a single positive blood ulute with coxiella burnetti or phase I IgG
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15
Q

are hacet group difficult to grow?

A

yes

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16
Q

how many blood cultures should be taken?

A
  • 3
17
Q

how can staphylococcus aureus be distinguished from coagulase-negaitve staph?

A
  • coagulase test
18
Q

what are staph?

A
  • gram positive cocci in clusters = staph
19
Q

what is staohylococcus epidermis in blood cultures?

A
  • most common coagulase-negtive stapylococcus
  • often a skin contaminant, BUT can infect prosthetic material eg intravascular line infections, prosthetic heart valves/joints
  • take more than one set of blood cultures to cnfirm significance
  • other skin contaminants: corynebacterium sp
20
Q

what are the presenting symtpms of acute endocarditits (compares to SBE)?

A
  • presents as overwhelimng spsis and cardiac fialure

- usually due to aggressive (virulneT) organisms such as staphylococcus aureus

21
Q

what is the subacute presentations of acute endocarditis?

A
  • fever
  • malaise
  • weight loss
  • tiredness
  • breathessness
22
Q

what are the subacute presentations of acute endocarditits?

A
  • fever
  • new of chnaging heart murmur
  • finger clubbing
  • splinter haemorrhages
  • spineomgeay
  • roth spots, janeway lesions, osler . nodes
  • microscopic haematuria
23
Q

how are streoptococci named?

A
  • ocygen requirement
  • lancefield groups
  • haemolysis on agar
  • biocemical tests
24
Q

where do viridans group streptococci live?

A
  • mouth
25
Q

what colour ar eviridans group stroptoccoi?

A
  • green
26
Q

what are the names of the alpha haemolytic strep?

A
  • strep mitis
  • strep sanguinis
  • strep mutans
  • strep slivarius
27
Q

what shows positive imagine for IE?

A
  • vegetation, abcess, psuedoaneuryms, intracardia fistula, valve perforation, new partial dehiscence of a valve prosthesis
28
Q

what is prosthetic valve endocarditits?

A
  • early (within 60 dyas) and late presentation
  • early - usulaly infected at the time of valve insertion and usually due to stephulococcus epidermis or staphylococcus aureus
  • late = up to mnay years after valave insetion - due to co-incidental bacteraemia, wide range of possible organisms
29
Q

what is endocarditis in PWID?

A
  • right sided endocarditits (tricuspid> mitral>aortic)
  • usually staph aureus
  • suspect in staphylococcus aureus plus septic pulmonary emboli
30
Q

what is the empirical treatment of endocarditis?

A
  • native valve endocarditis = amoxicillin and gentamicin IV
  • prosthetic valve endocarditits = vancomycin and gentamyocin IV, add in day 3 to 5 (delayed) rifampicin PO, often valve replacemnet is required
  • drug user endocarditis (MSSA) = flucolacillin IV
31
Q

what is specific endocarditits treatment?

A
  • stephylococcus aureus (not MSSA) = flucloxacillin IV
  • MRSA treat as per prosthetic valve - viridans streoptocicci = benzylpenicllin IV and gentamicin IV
  • enterococcus sp = amoxicillin / vancomycin and gentamicin IV
  • stephylococcus epidermis = vancomycin and gentamicin IV and rifampicin PO
32
Q

how is therpy monitored?

A
  • IV antibiotics usually given 4-6 weeks
  • monitor cardic fucntion, temperature and serum C-reactive protein )CPR_
  • if fialing on antibiotic therpy, consider referral for surgery early
33
Q

what is myocarditis?

A
  • most common in young people
  • symptoms - fever, chest pain, SOB, palpitations
    signs = arrhythmia, cardiac failure
34
Q

what is myocarditis caused by?

A
  • enteroVIRUSES - COXSACKIE A AND B, ENCHO VIRUS,
35
Q

how is myocarditis diagnosed?

A
  • viral PCR
36
Q

what is pericarditis?

A
  • occurs with myocardiits
  • chest pain
  • viral aetiology mainly, supportive treatment
  • bacteria less common
  • eg post cardiothoracic surgery, rarely secondary spread from endocarditits or pneumonia treatment, antibiotics and drainage