Infective Endocarditis

Question 1

Etiologic Agents - Major

Answer 1

S.aureus

Question 2

Etiologic Agents - Native Valve

Answer 2

Gram positive cocci

Question 3

Etiologic Agents - Prostatic Valve

Answer 3

Gram negative bacilli

Question 4

Etiologic Agents - IV Drug abuse

Answer 4

MRSA - Methicillin resistant Staph Auereus

Question 5

Diagnostic Criteria

Answer 5

2 Major or
1 Majour + 3 Minor or
5 Minor

Question 6

Major Criteria

Answer 6

1. Positive blood culture for infective endocarditis

2. Evidence of endocardial involvement

Question 7

Positive blood culture for infective endocarditis

Answer 7

1.Typical microorganism for infective endocarditis from 2 separate blood cultures:
Viridans streptococci, Streptococcus bovis, HACEK group*, or Community-acquired Staphylococcus aureus or enterococci, in
the absence of a primary focus, or
2. Persistently positive blood cultures for any microorganism
(i.e., from blood cultures drawn >12 hours apart), or

3. All of 3 or most of ≥ 4 separate blood cultures, with first and
   last specimens drawn at least 1 hour apart or
4. Single + BC for C. burnetii or antiphase I IGG titer of >1:800

Question 8

Evidence of endocardial involvement

Answer 8

1. Findings on echocardiogram positive for infective endocarditis
   a) Oscillating intracardiac mass
   on valve or supporting structures or in the path of regurgitant jets, or on
   iatrogenic devices, in the absence of an alternative anatomic explanation, or

    b) Abscess, or	
    c) New partial dehiscence of prosthetic valve, or	

2. New valvular regurgitation (increase or change in preexisting
   murmur not sufficient)

Question 9

Minor Criteria

Answer 9

1. Predisposition: predisp. heart condition or intravenous drug use
   
   2. Fever: ≥38°C (≥100.4°F)
   3. Vascular phenomena: arterial embolism, septic pulmonary
      infarcts, mycotic aneurysm, intracranial hemorrhage, Janeway lesions
   4. Immunologic phenomena: glomerulonephritis, Osler nodes,
      Roth spots, rheumatoid factor
   5. Microbiologic evidence: + BC but not meeting major criteria, or
      serology of active infection with organism consistent with IE

Question 10

Endocarditis due to Staphylococcus in the Absence of Prosthetic Materia

Answer 10

4-6W of:
nafcillin / oxacillin / cloxaciilin 
alternative A: non- β- lactam allergy -> cefazolin 
alternative B: vancomycin 
MSSA: vancomycin

Question 11

Staphylococcal Endocarditis in the Presence of a Prosthetic Valve or Other Prosthetic Material - MSSA

Answer 11

1. Orbenil (Cloxacillin) - 6W
2. Rifampin - 6W
3. Gentamicin - 2W

Question 12

Staphylococcal Endocarditis in the Presence of a Prosthetic Valve or Other Prosthetic Material - MRSA

Answer 12

1. Vancomycin - 6W
2. Rifampin - 6W
3. Gentamicin - 2W

Question 13

Native Valve Endocarditis due to Penicillin Susceptible Viridans Streptococci and Streptococcus bovis

Answer 13

Penicillin G / Ceftriaxone / Vancomycin - 4W

Penicillin G + Gentamycin - 2W (notice side effects)

Question 14

IE due to HACEK

Answer 14

1. Ceftriaxone - 4W

2. Ampicilin + Gentamicin - 4W

Question 15

IE Prophylaxis

Answer 15

All dental procedures that involve manipulation of gingival tissue:

1. Previous IE
2. Prosthetic Valve
3. Congenital Heart Disease