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Infective endocarditis risk factor Flashcards

1
Q

Who gets IE prophylaxis?

A

Unrepaired cyanotic (tetrallogy, truncus arteriosus, transposition, total anomalous venous return, pulmonary atresia, tircuspid atresia, Ebstein’s anomaly)
Repaired in last 6 months
Repaired but patch not endothelialised
prosthetic valve or valve material for repair
Indigenous RHD
Past history IE

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2
Q

What is the proph?

A

Oral amox for dental
IV amox

or if penacillin alergic
Clinda oral (dental)
Clinda IV
or Vanc IV

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3
Q

Which procedures not?

A 
Minor dental
Colonoscopy with biopsy
local anaesthetic
IDC
bronch with or without biopsy as per etg
vaginal delivery
TOE
GI or GU procedures with infection, where already covering enterococcus
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4
Q

If it’s culture negative, what is most likely?

A 
Brucella
Bartonella
HACEK
Coxiella burnetii
Trophynema whipplei

HACEK= haemophilus, aggregatibacter actinomycetemcomitans, cardiobacterium hominis, eikinella, kingella

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5
Q

More likely to die if?

A 
older
s aureus
healthcare associated
cerebrovascular and embolic events
heart failure
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6
Q

Most common symptoms?

A

Fever 80%
New or worsening murmur in 48/20 %
Haematuria in 25%

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7
Q

More likely to have a stroke/embolism if?

A

Mitral
Large
Staph

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8
Q

Blood cultures when?

A

Before the antibiotics

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9
Q

SErology for which organisms can be done if you get negaitive cultures?

A

bartonella
brucella
C burnetti

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10
Q

Roth spot how?

A

retinal haemorrhage with white/pale centre

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11
Q

Osler node how?

A

Immunologic origin

Tender

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12
Q

Janeway lesions how>?

A

non tender, small macular or nodular on palms/soles

VASCULAR mechanism

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13
Q

How long antibiotics if need a replacement during infection?

A

From the day of appropriate antibiotics, not from the day of surg

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14
Q

Do you use gent in staph endocarditis?

A

No in native

First two weeks in prosthetic

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15
Q

Indications for surgery?

A

Heart failure
Uncontrolled infection
Prevent embolic events
Fungal or pseudomonas
persisting fever and bacteraemia more than 7-10 days
very large vegetation- 30 mm or 10 after embolisation

Elevated LVEDP and pulm hypertension may substitute for clinical heart failure

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16
Q

Can you keep going with your aspirin during IE?

A

Yes you can. No evidence that reduces embolic events but is safe to take

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17
Q

How much endocarditis do you get post prosthetic valve>

A

1-4% per year first 4 years
then 1% per year
MECHANICAL JUST AS BAD AS PROSTHETIC

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18
Q

Are gut bugs a problem?

A

Only enterococcus

not really anaerobes or e coli

19
Q

Immunologic in acute or chronic

A

more in chronic as have time to produce

20
Q

Prosthetic valve endocarditis 1st 2 months?

A

staph epidermis (periop contamination)

after this spectrum returns to normal but slight increase in staph

21
Q

Prosthetic after 18 months

A

same as native valve

22
Q

Don’t forget can get pacemaker lead endocarditis!

A

causes a relapsing fever

Cannot cure medically
If old and not going to live long, long term antibiotics.
Otherwise need removal

23
Q

IVDU with “pneumonia” what would you do?

A

Give staph coverage until blood cultures back

24
Q

SBE organisms

ABE organism

A

ABE-staph

SBE-
1 Strep viridans (not actually a particular organism but many- mutans, bovis, mitis, sanguis, salivarus)
2. enterococcus faecalis
3. HACEK
4. uncommon but coag neg staph
5, bartonella, Q fever, brucella, legionella, tropheryma whipplei

25
Q

If you find these in a blood culture, which one most likely to point to underlying IE?

s mutans
s bovis
s sanguis
s mitor
enterococcus
A

S mutans! 14 to 1!
S bovis also high

enterococcus is 50/50

Group A strep- only 1:32- more line related/cellulitis

26
Q

Sens echo vs toe?

A

under 60% vs very high

27
Q

Duke criteria
5 minor
2 major
1 major + 3 minor

A

major

  • 2 x typical organisms separate cultures or continually pos BC or one culture with Q fever
  • echo criteria (dehiscing prosthetic valve, oscillating mass, abscess)
  • coxiella serology positive

minor

  • predisposition eg prosthetic or IVDU
  • fever over 38
  • micro not meeting major criteria
  • immunologic
  • vascular
28
Q

What are the immunological phenomena?

A

GN
Oslers nodes
Roth spots

very GORy!!!!!!!!

!!!!!!!!

29
Q

What are the vascular phenom?

A 
arterial embolism
septic pulm infarct
janeway
mycotic aneurysm
IC haemorrhage
30
Q

Difference if operate early vs late?

A

Study showed reduced embolisation but mortality the same

31
Q

How do you decrease the risk of embolic events?

A

Be on antibiotic therapy for at least two weeks.

32
Q

Empirical treatment native

A

Ben pen
Fluclox
Gent

33
Q

Empirical treatment prosthetic/PPM/ICD/healthcare associated infection/hypersens to penicillin/suspect MRSA

A

Vanc

Gent

34
Q

Strep viridans

A

15% have intermediate sensitivity so have to get penicillin MIC -ensure MIC under 2

If ok, use benpen + gent or just ben pen

If MIC over 2 use vanc

35
Q

Strep bovis

A

penicillin and a colonoscopy

36
Q

Enterococcus

A

gent
ben pen
amox/amp

if penicillin resistant
vanc
gent

If VRE
daptomycin or linezolid
often with surgery

37
Q

left sided staph

A

fluclox MSSA

vanc MRSA

38
Q

tricuspid staph

A

2 weeks fluclox

39
Q

HACEK

A

ceftriaxone 4 weeks

40
Q

culture negative

A

gent
ben pen
amox/amp

41
Q

What congenital heart disease is associated with bicuspid aortic?

A

Coarctation

Note also associated with a left dominant circulation!! And Turners!!

42
Q

What does bicuspid give you a risk of?

A

Aortic dissection and aneurysm formation

43
Q

How is the PR interval important?

A

May indicate an aortic abscess if prolonged

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