infective endocarditis (a complication of bacteremia Flashcards
Diagnosis - major
- Positive blood culture
- Positive lab tests
- imaging
- scan shows vegetation or abscess - surgical
- indication of IE with inspection
Diagnosis minor
- previous history of IE
- prosthetic valve
- previous valve repair
- congenital heart disease
- more than mild regurgitation or stenosis of any etiology
- endovascular intracardiac implantable electronic device
- hypertrophic obstructive cardiomyopathy
- injection drug use
Duration of therapy
ALWAYS determine MIC (will help us pick the proper agent and duration of therapy
usually duration is 4-6 weeks
Viridans group streptococci and S. gallolyticus - native valve endocarditis treatment options
MIC < or equal 0.12 (highly susceptible)
treatment 4 weeks
penicillin IV OR ceftriaxone IV
Penicillin IV PLUS gentamicin IV
Ceftriaxone IV PLUS gentamicin IV
vancomycin IV
Viridans group streptococci and S. gallolyticus - native valve endocarditis treatment options
MIC >0.12 to < or equal 0.5 (relatively resistant)
treatment 4 weeks
Penicillin Plus gentamicin
Ceftriaxone PLUS gentamicin
Vancomycin (option for patient who is allergic to b lactam therapy)
Viridans group streptococci and S. gallolyticus - prosthetic valve endocarditis treatment options
MIC < or equal to 0.12
treatment 6 weeks
penicillin IV OR ceftriaxone IV
Penicillin IV PLUS gentamicin IV
Ceftriaxone IV PLUS gentamicin IV
vancomycin IV (only for those allergic to B lactam)
Viridans group streptococci and S. gallolyticus - prosthetic valve endocarditis treatment options
MIC > 0.12 (relatively or fully resistant)
Treatment 6 weeks
Penicillin PLUS Gentamicin
Ceftriaxone PLUS gentamicin
Vancomycin (only for those allergic to B lactam)
Staphylococci - Native valve endocarditis
treatment for MSSA and MRSA
MSSA: Nafcillin or oxacillin (could do cefazolin for penicillin allergic non anaphylactic) - 6 weeks
MRSA: vancomycin or daptomycin - 6 weeks
Staphylococci - prosthetic valve endocarditis
treatment for oxacillin susceptible and oxacillin resistant
treatment is greater than or equal to 6 weeks
Oxacillin susceptible:
Nafcillin or oxacillin PLUS rifampin IV/PO PLUS gentamicin
Oxacillin resistant:
Vancomycin PLUS rifampin PLUS gentamicin
Enterococci native or prosthetic valve endocaditis
treatment for penicillin and gentamicin susceptible
treatment is generally 4-6 weeks
Ampicillin IV PLUS gentamicin
Penicillin IV PLUS gentamicin
Ampicillin PLUS ceftriaxone
Enterococci Native or prosthetic valve
Penicillin susceptiblle and aminoglycoside resistant strains
duration 6 weeks
Ampicillin IV plus Ceftriaxone
Enterococci Native or prosthetic valve
penicillin susceptible, streptomycin susceptible, gentamicin resistant strains
duration 4-6 weeks
Ampicillin PLUS streptomycin IV/IM
Penicillin PLUS Streptomycin IV/IM
Enterococci Native or prosthetic valve in patients unable to tolerate B lactam therapy
with vancomycin and aminoglycoside susceptible strains
Duration 6 weeks
Vancomycin IV PLUS Gentamicin IV/IM
Enterococci Native or prosthetic valve
intrinisc resistance to penicillin or B lactam
Vancomycin IV PLUS Gentamicin
duration 6 weeks
Enterococci - native or prosthetic valve endocarditis
Pen, amiino, and vanc resistant strains
Treatment > 6 weeks
Daptomycin
Linezolid
HACEK organisms native or prosthetic treatment
Duration for native - 4 weeks
duration for prosthetic - 6 weeks
Ceftriaxone DOC
Ampicillin IV or Unasyn IV
Ciprofloxacin PO
Non-HACEK gram negative bacilli treatment
this is super rare and could require surgical intervention
can use combo of b lactam PLUS aminoglycoside OR FQ for 6 weeks
Fungal endocarditis
duration >6 weeks
treatment is fluconazole PO
Culture negative endocarditis - native valve
treatment for acute onset and subacute
Vancomycin PLUS cefepime - acute onset
Unasyn PLUS vancomycin - subacute onset
Culter negative endocarditis - prosthetic valve
early < 1 year
late >year
Duration 6 weeks
early : Vancomycin IV PLUS Gentamicin PLUS rifampin PLUS cefepime
Late: Vancomycin PLUS ceftriaxone
Culture negative endocarditis
suspected bartonella, culture negative treatment and documented bartonella, culture positive
Duration 6 weeks
suspected: Ceftriaxone IV PLUS Gentamicin WITH/WITHOUT doxycycline IV/PO
Documented: Doxycycline IV/PO PLUS Gentamicin
Prophylactic antimicrobial regimens for dental procedures
beneficial in patients with underlying cardiac conditions associated with highest risk of adverse outcomes from IE
options
Amoxicillin
if patient cannot take oral - ampicillin, cefazolin, or ceftriaxone
if patient is allergic to pen: cephalexin, clindamycin, azithromycin or clarithromycin
if allergic to pen and cannot take oral - clindamycin or cefazolin
