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**Host and Defense > Intravascular infections > Flashcards

Intravascular infections Flashcards

1
Q

What is Bacteremia?

A

Presence of Bacteria in the blood stream

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2
Q

What does the suffix “emia” refer to?

A

circulation

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3
Q

Describe Transient Bacteremia

A
  • Clearance exceeds entry

- Source is local infection somewhere (GU, skin, lungs, bone, joint, abdomen)

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4
Q

Describe Continiuous bacteremia

A
  • Seeding exceeds clearance capacity
    • endovascular infections
  • Septicemia (sepsis syndrome)
    • Clearance mechanisms subverted (virulence)
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5
Q

List the Endovascular infections

A
  1. Infective Endocarditis
  2. Infected Thrombus (septic Thrombophlebitis)
  3. Mycotic Aneurysm (arterial wall infection)
  4. Infections of intravscular devices:
    • Catheters
    • Pacemaker and defibrillator wires
    • Left ventricular assist devices
    • Arterial Conduits
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6
Q

Describe the importance of blood cultures regarding vascular infections

A
  • Blood is removed aseptically
  • Dilution of Blood sample into broth
  • Sensitivity
    • The important variable is volume
  • Specificity
    • False Positivity Rate varies
  • The special case of IE is timing
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7
Q

What would predispose someone for endocarditis?

A
  1. Congenital Heart Disease
  2. Rheumatic heart Disease
  3. Conditions leading to Bacteremia
    • Dental
    • Urological
    • Gastrointestinal
  4. Intravenous Drug Abuse
  5. Hospitalization
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8
Q

What was the survival rate of Endocarditis during the pre-antibiotic era?

A

0% all dead within about 1 year

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9
Q

Describe the pathogenesis of Endocarditis

A
  1. Turbulent Blood flow
  2. Endothelial cell activation
  3. Fibrin and Platelet Deposition
  4. Silent of clinical bacteremia seed sterile vegetations
  5. Bacteria grow within fibring vegetations
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10
Q

What does the endocardium lack and why is that a problem?

A

-Lacks capillary circulation, which is required for neutrophils to access the site of infection.

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11
Q

Where does the endocardium recieve it’s nourishment from?

A

The blood stream

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12
Q

What structures are part of the endocardium?

A
  • Valves
  • Chordae
  • Papillary Muscle attachments
  • Atria
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13
Q

IE is characterized by what?

A

Unrestricted microbial replication within vegetations leading to in vivo bacterial colonies

**Bacteria embedded within vegetations are impossible to entirely eradicate

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14
Q

What are the major criteria for diagnosis of Endocarditis?

A
  1. Continuous bacteremia

2. Target lesion on valve, supports or endocardium (by ECHO or new murmur)

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15
Q

What are the minor criteria for the diagnosis of Endocarditis?

A
  1. Fever
  2. Predisposing heart condition
  3. Injection drug user
  4. Embolic phenomena
  5. Immunological phenomena
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16
Q

What are the main types of microorganism that we see causing Endocarditis

A

THE MAIN 3:

  1. Staphylococci
  2. Streptococci
  3. Enterococci

OTHERS:

  1. Gram negative Bacilli (IVDA)
  2. Fungi (candida sp)
  3. A ton of other ones
17
Q

If you isolate a bacterial from the bloodstream, the presence of which bacteria will indicate the highest possiblity for endocarditis?

A

S. Mutans

The idea on this table from slide 26 is that the less virulent a bacteria you find in a blood sample, the more likely you are to have endocarditis

18
Q

List some complications of endocarditis

A
  1. Congestive Heart Failure
  2. Stroke
  3. Infarcts
  4. Glomerulonephritis
  5. Mycotic Aneurysms
  6. Abscesses
    • Local (myocardium)
    • Distant (embolic seeding)
19
Q

What are some indications that would put you at high risk for adverse outcomes from IE?

A
  1. Prosthetic heart valves or prosthetic material inserted for cardiac valve repair
  2. Previous infective endocarditis
  3. Congenital heart disease (CHD)
    • Unrepaired cyanotic CHD including paliative shunts and conduits
    • Completely repaired CHD with prosthetic material during first 6 months after procedure
    • Repaired CHD with residual defects where endothelialization is inhibited
      - Cardiac Tx patients who develop valvulopathy
20
Q

How can IE be prevented?

A
  1. Prophylactic antibiotics prior to procedures
    • Prosthetic heart valves
    • Previous IE
    • Congenital heart Diseases
    • Heart Tx with valvulopathies
  2. IV or PO regimens at time of procedures
21
Q

How can IE be treated?

A
  1. Intravenous therapy
  2. Bactericidal regimen
  3. Length of treatment–2,4,6,8 weeks
  4. Special tests for antibiotic sensitivity
  5. Surgery
22
Q

What does HACEK stand for?

A 
Haemophilus
Aggregatibacter
Cardiobacterium
Eikenella
Kingella

**Host and Defense (31 decks)

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