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week 67 > Infective endocarditis-Dr. Hasan > Flashcards

Infective endocarditis-Dr. Hasan Flashcards

1
Q

What is Infective Endocarditis?

A
  • Microbial infection of the endothelial lining of the heart/heart valves
  • on or adjacent to abnormal valve
  • occurs w/congenital/acquired cardiac defects
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2
Q

When should a patient have prophylaxis against Infective Endocarditis before dental procedures?

A

Dental procedures that involve manipulation of gingival tissue, manipulation of periapical of teeth, or perforation of oral mucosa in patient with:

  • Prosthetic Cardiac valves
    • transcatheter
    • implanted prosthesis
    • Homograft
  • Prosthetic material for valve repair
    • annuloplastic rings & chords
  • Previous Infective Endocarditis
  • Unrepaired cyanotic CHD
    • (Congenital Heart Disease)
  • completely repaired CHD w/ prosthetic material or device by surgery OR catheter during first 6 months after procedure
  • Repaired CHD w/residual shunts or valve regurgitation at the site or adjacent to the site of prosthetic patch or device
  • Cardiac Transplant w/valve regurgitation due to abnormal structured valve
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3
Q

What causes infective endocarditis

A

Acquired in community, hospital, or through IV

  • Bacteria
  • Fungal
  • Virus
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4
Q

What are the most common microorganisms that are pathogens in IE?

A
  • Streptococci
    • oral Streptococci-viridans group streptococci (VGS)
  • Staphylococci
  • Enterococci
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5
Q

What is associated with poorer outcomes in IE?

A
  • Staphylococcus aureus IE
  • Prosthetic Valve IE
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6
Q

What microorganisms cause the rest of IE? (Not the most common)

A
  • Gram-negative bacilli
  • HACEK oragnisms
  • Fungi
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7
Q

What is the major criteria for diagnosis of endocarditis?

A
  • Major Criteria:
    • persistent +ve blood culture for typical organisms
    • ECHO:
      • vegetation
      • dehiscence
      • abscess
    • New valve regurgitation murmur
    • Coxiella burnetii infection
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8
Q

What is the minor criteria for diagnosis of endocarditis?

A
  • Minor:
    • Predisposing heart condition or IV drug use
    • Fever: -38 C
    • Vascular:
      • emboli to organs/brain, hemorhages
    • Immunologic:
      • glomerulonephritis
      • Osler’s nodes
      • Roth spots
      • Rheumatoid Factor
    • Positive Blood cultures that do not meet specific critic
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9
Q

What is the criteria for Definite, Possible, and Rejected Endocarditis?

A
  • Definite:
    • 2 major
    • 1 major & 3 minor
    • 5 minor
    • Histological findings
    • +ve stain or cultures from surgery or autopsy
  • Possible:
    • 1 major & >1 minor
    • 3 minor
  • Rejected:
    • resolution w/in <4 days of Abx(Antibiotics)
    • Alternate diagnosis is made
    • No evidence of IE found at surgery or autopsy
      • after <4 days abx
    • definite or possible criteria not met
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10
Q

What is it important to diagnose and tx infective endocarditis?

A
  • 100% fatal if not treated
  • W/antibiotic tx–40% mortality rate
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11
Q

what is the fatality rate for each type of microorganism on Native valve (NVE)?

A
  • Streptococcus: <5%
  • Staphylococcus: 25-40%
  • Gram negatives: 75-83%
  • Fungi: 50-60%
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12
Q

Infective Endocarditis Complications:

A
  • Free bacterial Vegetation causing systemic embolus
  • Bacterial infection on:
    • valve
    • endocardial surface
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13
Q

Bacterial Vegetations

A
  • Bacteria or other germs multiply and form clumps w/other cells and matter in the blood of heart
  • as IE worsens, pieces break off and travel to any organ or tissue in body
  • Pieces/emboli can block blood flow or cause new infection
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14
Q

Infective Endocarditis: Heart Complications/Problems

A
  • Most common complication of IE
  • occur in ⅓ to ½ of infected
  • Include:
    • Heart murmur
    • heart failure
    • heart valve damage
    • heart block
    • heart attack (rare)
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15
Q

Infective Endocarditis: Central Nervous System Complications

A
  • occur in 20-40% infected
  • most often occur when vegetation pieces(=emboli) lodge in brain
  • Emboli can cause:
    • brain abscesses
      • local infection
    • Meningitis
      • widespread Brian infection
    • Strokes or Seizures
      • if they block blood vessels or affects brain’s electrical signals
      • long term damage to brain
      • can be fatal
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16
Q

Infective endocarditis: Lung complications

A
  • Right-sided infective endocarditis
    • IE affects right side of heart
  • Pulmonary embolism (PE)→lung damage
  • Pneumonia
  • Buildup of fluid or pus around lungs
17
Q

How is dentistry involved?

A
  • Dental procedures are a source of bacteremia’s, but account for only a small number of bacteremia’s
  • Bacteremia’s occur daily from normal, physiological activities (absence of visible bleeding)
    • Chewing
    • brushing
  • Antibiotic prophylaxis does not prevent development of endocarditis
18
Q

Infective Endocarditis & Antimicrobial Prophylaxis

A
  • All guidelines are expert based instead of evidence based
    • efficacy of preprocedure abx for prevention of IE has never been proven
  • no evidence that Antibiotic Prophylaxis before dental procedures is effective or ineffective
19
Q

Current Antibiotic Prophylaxis Guidline prior dental produce

A
  • Prosthetic Valve
    • transcatheter-implanted prostheses
    • Homograft
  • Prosthetic material use in valve repair
    • annuloplasty rings & chords
  • History of infective endocarditis
  • Cardiac transplant w/valve regurgitation due to abnormal valve structure
  • Congenital Heart Disease:
    • unrepaired cyanotic CHD
      • palliative shunts & conduits
    • Repaired CHD w/residual shunts or valve regurgitation at site of or adjacent to the site of prosthetic patch or device
20
Q

What patients is Prophylaxis no longer recommended for?

A
  • Mitral Valve Prolapse
  • Rheumatic Heart Disease
  • Congenital Heart Conditions:
    • Atrial Septal Defect
    • Ventral Septal Defect
    • Hypertrophic Cardiomyopathy
  • Calcific aortic stenosis
  • Bicuspid aortic valve
21
Q

Antibiotic Regimens: oral-no allergy

A

Amoxicillin

22
Q

Antibiotic Regimens: Oral-allergy penicillin or ampicillin

A
  • cephalexin*
  • clindamycin
  • Azithromycin
  • Clarithromycin
23
Q

Mortality due to Staphylococcus aureus

A

40% w/prosthetic valve IE

24
Q

Standard of care for Prosthetic Joint Patients

A
  • Does not require Antibiotics
  • Give if:
    • the patient insists, have the physician write the Rx
    • Immunocompromised
24
Q

Antibiotic Regimen: Unable to take oral meds and allergic to penicillin or ampicillin

A
  • Cephazolinn
  • ceftriazone
  • Clindamycin phosphate
26
Q

What is the mortality due to VGS?

A
  • Native valves=5%
  • Prosthetic Valves=20%
27
Q

Antibiotic Regimen: Unable to take oral medication

A
  • IM or IV:
    • Ampicillin
    • Cephazolin
    • Ceftriaxone

week 67 (5 decks)

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