practicum: infective endocarditis

Question 1

risk factors for IE

Answer 1

predisposing heart conditions, PWID

Question 2

what is the most common IE pathogen in PWID

Answer 2

staph. aureus

Question 3

regimens for native valve endocarditis to target staph. aureus: oxacillin susceptible strains

Answer 3

nafcillin or oxacillin

Question 4

regimens for native valve endocarditis to target staph. aureus: oxacillin susceptible strains– penicillin allergic patients

Answer 4

cefazolin

Question 5

regimens for native valve endocarditis to target staphylococcus aureus- oxacillin resistant strains

Answer 5

Vancomycin, Daptomycin

Question 6

target vancomycin dose for therapeutic drug monitoring for IE

Answer 6

adjust vanco dose to achieve trough concentration of 10-20 ug/mL

Question 7

Vancomycin AUC/MIC target for therapeutic drug monitoring for IE

Answer 7

400-600 mg*hour/L (achieve within 24-48 hours)

Question 8

most likely pathogen if GPC arranged in pairs and chains

Answer 8

enterococcus faecalis

Question 9

most likely pathogen if GPCs arranged in clusters

Answer 9

staph. aureus

Question 10

most likely pathogen if GPCs arranged in chains

Answer 10

streptococcus; viridans streptococcus

Question 11

IE microbiological etiologies

Answer 11

staphylococci, viridans streptococci, enterococci

Question 12

what constitutes a set of blood cultures

Answer 12

one aerobic culture bottle and one anaerobic culture bottle

Question 13

what is the duration of therapy

Answer 13

6 weeks

Question 14

what is the regiment for native valve endocarditis due to MRSA

Answer 14

vancomycin 30 mg/kg/day IV in 2 equally divided doses
daptomycin 8 mg/kg/dose

six week duration

Question 15

if the ePlex tests detects Staph. aureus WITHOUT the mecA or mecC resistance gene— antibiotic regimen?

Answer 15

switch from Vancomycin to oxacillin/nafcillin or cefazolin

six week duration

Question 16

ePlex test detects staph with mecA resistance gene and patient has a PROSTHETIC valve

Answer 16

mecA predicts MRSA and the patient has a prosthetic valve:

so Vancomycin and rifampin for 6 weeks, with gentamicin for the first 2 weeks of therapy