Infective Endocarditis part one

Question 1

what symptoms may a patient with Infective Endocarditis present with?

Answer 1

fever, chills, weakness, dyspnea, night sweats, weight loss, and / or malaise

Question 2

what signs may a patient with Infective Endocarditis present with ?

Answer 2

fever
heart murmur (may be new or changed if murmur is typically present)
embolic phenomenon (purplish discoloration of the skin)
splenomegaly
skin manifestations (Osler’s nodes and laneway lesions)

Question 3

what are the major jones criteria?

Answer 3

Blood culture positive for infective endocarditis

Evidence of endocardial involvement

Question 4

what are the three pathogen groups that cause a majority of infective endocarditis cases?

Answer 4

Staphylococci (30-70%)
Streptococci (9-38%)
Enterococci (5-18%)

Question 5

first step to treatment of IE is to isolate what?

Answer 5

the pathogen responsible for infection

Question 6

after isolating the pathogen, what is the net step in treating IE?

Answer 6

to determine the antimicrobial susceptibilities

this is important due to the escalating level of antibiotic resistance

Question 7

once the pathogen is isolated and antimicrobial susceptibly is determined, treating IE requires a high dose of what? for how long?

Answer 7

a high-dose, parenteral (not administered by the mouth and alimentary canal), bactericidal antibiotics for an extended period

Question 8

why do antibiotics given for IE need to be high does and for an extended period of time?

Answer 8

this is done to achieve bactericidal concentrations within vegetations

this is difficult because the microorganisms are enclosed within valvular vegetations and fibrin deposits

Question 9

_________ is an important adjunct in the management of both native or prosthetic valve endocarditis

Answer 9

surgery

Question 10

what is the surgical option for IE treatment

Answer 10

valvectomy and value replacement

Question 11

an increase in which specific patient population has lead to an increase in infective endocarditis due to staphylococci organisms?

Answer 11

intravenous drug users

Question 12

the increase in the Staphylococcal Endocarditis prevalence may also result from

Answer 12

increased use of peripheral and central venous catheters

increased frequency of valve replacement surgery

Question 13

which organism is the most common organism causing infective endocarditis among those with IVDA and persons with venous catheters?

Answer 13

S. aureus 60 to 70 %

Question 14

which organism group and which specific organism are more commonly associated with prosthetic valve endocarditis?

Answer 14

Coagulase-negative staphylococci

specifically, Staphylococcus epidermidis

Question 15

which valve is frequently affected in IV drug users infected with Staphylococcus Endocarditis?

Answer 15

tricuspid – aka right sided IE

Question 16

how is Staphylococcus Endocarditis treated in IV Drug users?

Answer 16

a 2 week course of nafcilin or oxacillin plus an aminoglycoside

Question 17

which organism is most common isolated leading to Streptococcal endocarditis?

Answer 17

strept viridans

Question 18

Streptococcus sanguinis, Streptococcus oralis, Streptococcus salivarius, Streptococcus mutans, and Gemella morbillorum are examples of which group of organisms?

Answer 18

strept viridans

Question 19

strept viridans commonly inhabit which part of the human body?

Answer 19

mouth and gingiva

Question 20

is Streptococcal endocarditis typically subacute or acute?

Answer 20

subacute

Question 21

strept viridans is common causes of endocarditis involving which valves?

Answer 21

native valves

Question 22

Enterococci are normally inhabitants of which part of the human body?

Answer 22

GI tract and occasionally of the anterior urethra

Question 23

which organism is most common isolated leading to Enterococcal endocarditis?

Answer 23

E. Faecalis

Question 24

are organisms of the HACEK group gram positive or negative?

Answer 24

negative

Question 25

what are Haemophilus parainfluenzae and Haemophilus aphrophilus?

Answer 25

Fastidious gram-negative bacteria part of HACEK group causing Enterococcal Endocarditis

Question 26

how do you treat Enterococcal Endocarditis associated with HACEK

Answer 26

high dose ampicillin with gentamicin for 4 weeks

Question 27

what is Actinobacillus actinomycetemcomitans?

Answer 27

Fastidious gram-negative bacteria part of HACEK group causing Enterococcal Endocarditis

Question 28

Enterococcal Endocarditis associated with HACEK leads to which type of endocarditis?

Answer 28

sub acute illness with large vegetations and emboli

Question 29

5% to 10% of native valve, community-acquired infective endocarditis are due to?

Answer 29

Enterococcal Endocarditis associated with HACEK

Question 30

what is Cardiobacterium hominis?

Answer 30

Fastidious gram-negative bacteria part of HACEK group causing Enterococcal Endocarditis

Question 31

which group is drugs of choice for endocarditis?

Answer 31

Beta lactam antibiotics

Question 32

penicillin G or ceftriaxone is useful to treat which type of IE?

Answer 32

streptococcal

Question 33

Nafcillin is useful to treat which type of IE?

Answer 33

staphylococcal

Question 34

what is Eikenella corrodens?

Answer 34

Fastidious gram-negative bacteria part of HACEK group causing Enterococcal Endocarditis

Question 35

Ampicillin is useful to treat which type of IE?

Answer 35

enterococcal

Question 36

what is Kingella kingae?

Answer 36

Fastidious gram-negative bacteria part of HACEK group causing Enterococcal Endocarditis

Question 37

other than beta lactic antibiotics, which other antimicrobial therapies may be used to treat IE?

Answer 37

ahminoglycosides, vancomycin, Fluoroquinolones

Question 38

empiric therapy should cover which organisms?

Answer 38

staphylococci (methicillin-susceptible and methicillin-resistant)
streptococci,
and enterococci

Question 39

Empiric Drug Therapy for Native Valves when IE is highly suspected

Answer 39

vancomycin plus ceftriaxone

Question 40

Empiric Drug Therapy for Prosthetic Valves when IE is highly suspected

Answer 40

vancomycin plus gentamicin plus rifampin