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Fall 2024 > Treatment of Infections of the Cardiovascular System > Flashcards

Treatment of Infections of the Cardiovascular System Flashcards

1
Q

What pathogens are likely if IVDU

A

Staph aureus
Coagulase-negative staph
B-hemolytic strep
Fungi
aerobic gram-neg bacilli

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2
Q

What pathogens are likely if prosthetic or indwelling cardiac device

A

Staph aureus
coag-neg staph
Fungi
Aerobic gram-neg bacilli

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3
Q

What pathogens are likely if GU or gynecologic disorder including pregnancy and birth

A

Enterococci
Group B strep
Listeria mono
Aerobic gram-neg bacilli
Neisseria gonorrhea

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4
Q

What pathogens are likely if poor dental hygiene/dental procedure

A

strep viridians
HACEK

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5
Q

What pathogens are likely if chronic skin disorder/infection

A

staph aureus
B-hemolytic strep

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6
Q

What pathogens are likely if pneumonia or meningitis

A

strep pneumo

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7
Q

What pathogens are likely if GI complications

A

strep galloyticus
enterococci

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8
Q

What is the classification for endocarditis?

A

Duke criteria

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9
Q

Definite IE

A

pathological criteria (culture or pathologic lesions, or vegetation abscess)
Clinical criteria:
- two major
- one major and three minor
- five minor

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10
Q

Possible IE

A

One major criteria and one minor criteria
3 minor criteria

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11
Q

Major criteria

A

Positive blood culture with typical organisms - 2 obtained > 12 hours apart
>= 3 with first and last obtained at least 1 hour apart

Pos blood culture or IgG titer for Coxiella Burnetti

Endocardial involvement

Echocardiographic evidence of IE

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11
Q

Rejected

A

firm alternative diagnosis
resolution of IE syndrome with AB therapy less than 4 days
No pathological evidence of IE
Does not meet “possible” criteria

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12
Q

Minor criteria

A

predisposing heart condition or IVDU

Temperature >38C

Vascular phenomenon (Jawney lesions, mycotic aneurysms)

Immunological phenomenon (osler nodes, roth spots)

Pos blood culture not meeting major criteria

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13
Q

Antimicrobial therapy duration

A
  • obtain 2 blood cultures every 24-48 hours until bacteremia has cleared
  • Counting of AB therapy days starts the first day when blood cultures are negative
  • Valve replacement performed and tissue cultures are positive = AB duration begins after surgery
  • Empiric antibiotic therapy
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14
Q

What regimen should be used if native valve or late prosthetic valve (>=12 months post surgery)

A
  1. Penicillin G or Ampicillin
  2. Nafcillin or Oxacillin
  3. Gentamicin
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15
Q

What regimen should be used in the case of a severe B-lactam allergy

A
  1. Vancomycin
  2. Gentamicin
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16
Q

What regimen should be used if native valve with IVDU or evidence of R sided IE

A
  1. Vancomycin or Daptomycin
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17
Q

What regimen should be used if early prosthetic valve (<12 months post surgery)

A
  1. Vancomycin
  2. Gentamicin
  3. Rifampin
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18
Q

What can be used to determine specific pathogen therapy

A
  1. blood culture results
  2. intraoperative tissue obtained
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19
Q

How to treat viridians group strep and S. Gallolyticus if Penicillin MIC is <= 0.12

A

Penicillin G or Ceftriaxone for 4 weeks
- If uncomplicated native valve, 2 weeks and add Gentamicin

20
Q

How to treat viridians group strep and S. Gallolyticus if Penicillin MIC is 0.12 - 0.5

A
  1. Penicillin G + Gentamicin OR
  2. Ceftriaxone +/- Gentamicin
    P and C = 4 weeks, Gentamicin = 2 weeks
21
Q

How to treat viridians group strep and S. Gallolyticus if Penicillin MIC is >=0.5

A
  1. Penicillin G OR
  2. Ceftriaxone + Gentamicin
    P and C = 4 weeks, Gentamicin = 2 weeks
22
Q

How long should treatment be if patient have a prosthetic valve?

23
Q

What should be used in place of Pen G if B-lactam allergy

A

Vancomycin

24
Q

How should S Pneumo be treated?

A

Penicillin OR Cefazolin OR Ceftriaxone
4 weeks

25
Q

How should Penicillin resistant S Pneumo be treated

A

No meningitis - high dose penicillin OR 3rd generation cephalosporin
4 weeks
If meningitis suspected - Cefotaxime OR ceftriaxone
4 weeks

26
Q

How to treat S pyogenes

A

Penicillin G OR Ceftriaxone
4-6 weeks

27
Q

How to treat Group B, C, or G B-hemolytic strep

A

Penicillin G OR Ceftriaxone + Gentamicin
PCN and ceft = 4-6 weeks
Gentamicin = 2 weeks

28
Q

How is methicillin susceptible staph with a native valve treated

A

Nafcillin OR Oxacillin
6 weeks (2 if uncomplicated R sided EC)

29
Q

How is methicillin susceptible staph with a prosthetic valve treated

A

Nafcillin OR oxacillin +
Rifampin +
Gentamicin
V and R >= 6 weeks, Gent = 2 weeks

30
Q

How is methicillin resistant staph with a native valve treated

A

Vancomycin OR Daptomycin
6 weeks

31
Q

How is methicillin resistant staph with a prosthetic valve treated?

A

Vanc + rifampin + gentamicin
V and R >= 6 weeks, gent = 2 weeks

32
Q

How are enterococci that are susceptible to penicillin and gentamicin treated

A

Ampicillin OR Pen G + Ceftriaxone
4-6 weeks
OR Ampicillin + Ceftriaxone
6 weeks

33
Q

How to treat enterococci resistant to aminoglycosides or gentamicin

A

Ampicillin + Ceftriaxone
6 weeks
OR Ampicillin OR Pen G + Streptomycin
4-6 weeks

34
Q

How to treat enterococci resistant to penicillin or penicillin allergy

A

Vancomycin + Gentamicin
6 weeks

35
Q

How to treat enterococci resistant to Penicillin, Aminoglycosides and Vancomycin

A

Linezolid OR Daptomycin
>6 weeks

36
Q

What are some common characteristics Right Sided IE

A
  1. Most common with IVDU
  2. Typically tricuspid
  3. Staph aureus predominant
37
Q

What is the recommended empiric therapy for right sided IE and what specifically needs covered?

A

Staph:
Nafcillin OR Oxacillin OR Daptomycin + empiric coverage for MRSA
Uncomplicated - 2 weeks
Complications (renal failure, meningitis, MRSA) or use of vancomycin - Duration should be 4-6 weeks

38
Q

What are the common organisms assoc. with infected implantable devices?

A

Staph or MRSA

39
Q

What two things should be done in the case of an infected implant?

A
  1. Initiate empiric vancomycin to cover MRSA before…
  2. Complete hardware removal

Duration-at least 2 weeks after hardware removal for blood stream infections
4-6 weeks for complicated infections (endocarditis, osteomyelitis)

40
Q

In what conditions is endocarditis prevention recommended?

A
  1. Prosthetic valve or valve material
  2. Previous IE
  3. Congenital heart disease
  4. Cardiac transplant with valvopathy
41
Q

In what procedures is prevention of infective endocarditis recommended?

A
  1. Dental procedures with tissue involvement or mucosal perforation
  2. Invasive respiratory procedure with incision or biopsy of mucosa
  3. GI or GU procedure with established site of infection
  4. Surgical procedure on infected skin or surrounding tissue
  5. Cardiac surgery
42
Q

What infective endocarditis prevention is recommended for adults getting a dental procedure with no penicillin allergy

A

Give 30-60 minutes before procedure:
1. Amoxicillin 2g PO x 1 OR
2. Ampicillin 2g IM or IV x1 OR
3. Cefazolin OR Ceftriaxone 1g IM or IV

43
Q

What is the pediatric dosing for infective carditis prevention in pediatric patients?

A

Amoxicillin 50mg/kg PO x 1
Ampicillin 50mg/kg IM or IV x 1
Cefazolin or Ceftriaxone 50mg/kg IM or IV x 1
*Give 30-60 minutes before procedure

44
Q

What can be given other than penicillin for endocarditis prevention (what is an equivalent)

A

May use equivalent dose of another first or second generation PO cephalosporin

45
Q

What should be given to adults for EI prevention before dental procedures if they have a penicillin allergy

A

Cephalexin
Clindamycin
Azithromycin or clarithromycin
Cefazolin or Ceftriaxone

46
Q

What should be given to children for EI prevention before dental procedures if they have a penicillin allergy

A

Same as adult options:
Cephalexin
Clindamycin
Azithromycin or clarithromycin
Cefazolin or ceftriaxone

Fall 2024 (34 decks)

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