Term
subacute onset: Strep Viridans or HACEK (Haemophylus parainfluenzae, Actinobacillus, Cardiobacterium, Eikenella, Kingella)
acute onset: Staphylococcus aureus |
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Definition
| common organisms associated with native valve IE |
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Term
subacute onset: Staphylococcus epidermidis, Enterococcus
acute onset: Staphylococcus aurues |
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Definition
| common organisms associated with prosthetic valve IE |
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Term
occurs most frequently in critically ill patients
IV drug users: HIV, polymicrobial, recurrent, cocaine users at high risk (increased HR and BP = increased pressure on the heart)
areas of high turbulence: small ventricular septal defects with a jet lesion (hole in the heart), valvular stenosis resulting in insufficient valves
mechanical stress and pressure exerted on the valves: mitral > aortic > tricuspid > pulmonic
[image]
common dental procedures that cause bacteremia (from normal flora): extraction, periodontal surgery, chewing candy, teeth brushing and oral irrigation, devices
upper airway: bronchoscopy, tonsillectomy, nasotracheal suctioning/intubation
mechanical heart valves/bioprosthetic valves
previous IE |
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Definition
| common risk factors for IE |
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Term
| predisposing or congenital cardiac abnormality -> altered endothelial surface -> platelet and fibrin deposition (non-bacterial thrombus) -> transient bacteremia -> colonization/adherence -> platelet and fibrin deposition and meshing -> multiplication of organisms -> destruction of underlying tissue -> fibrosis -> abscesses -> fragment release/septic emboli -> infarction |
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Definition
| typical pathophysiologic mechanism of IE |
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Term
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Definition
bacteria, platelets, and fibrin aggregate in deposits forming a protective cover
usually located along the line of closure of a valve leaflet
may be friable (movable): can embolize to organs (kidneys, spleen, coronary system, and brain are most frequent) |
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Term
cerebral emboli are most common neurologic manifestations of IE
pulmonary when right sided IE is present: pulmonary embolism, pneumonia, pleural effusion, empyema (a collection of pus in the space between the lung and the inside of the chest wall (pleural space))
skin:
petechiae: small red hemorrhages
Osler nodes: PAINFUL red areas usually on the pads of the hands and soles of feet; believed to be due to antigen/antibody complexes
splinter hemorrhages
Janeway lesions: PAINLESS hemorrhagic emboli; typically occurs on hands and soles of feet
eye: Roth spots - retinal infarction |
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Definition
| embolic complications of IE (brain, lungs, skin, and eyes) |
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Term
fever: most common (90%); may be low grade
heart murmur: new or changing
splenomegaly
signs of renal failure from infarcts
embolic phenomenon
skin manifestations: petechiae, Osler nodes, splinter hemorrhages, Janeway lesions
clubbing |
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Definition
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Term
sweats
skin lesions
stroke
back pain
hematuria |
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Definition
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Term
elevated erythrocyte sedimentation rate
elevated creatinine
proteinuria, hematuria, red cell casts, pyruria, white cell casts, bacteriuria - only seen if embolism to the kidney
thrombocytopenia, leukocytosis
anemia |
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Definition
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Term
blood cultures are the most important diagnostic test
3-6 TESTS IN THE FIRST 24 HOURS AFTER PRESENTATION
first 2 sets of cultures yield the etiologic agent more than 90% of the time
HOLD CULTURES FOR 1 MONTH BECAUSE SOME PATHOGENS ARE SLOW GROWING
previous antibiotics decrease bacterial yield
high rates of negative cultures in fungal IE |
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Definition
| how should blood cultures be taken for IE? |
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Term
transthoracic echocardiogram (TTE): less invasive and easy to perform; less sensitive (50%) due to interference
transesophagela echocardiogram (TEE): more sensitive (90%); better at evaluating posterior valves; cost effective but more invasive |
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Definition
| what radiologic tests are useful in evaluating for the presence of IE? |
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Term
Major Criteria:
Blood Culture Positive for IE -
typical microorganisms consistent with IE from 2 separate blood cultures (S. viridans, S. bovis, HACEK, S. aureus, or EC in absence of primary focus)
OR
at least 2 positive blood cultures drawn > 12 hours apart
OR
all of 3 or a majority of 4 or more separate blood cultures positive (with 1st and last sample drawn at least 1 hour apart)
OR
single positive blood culture for Coxiella burnetti (Q fever)
Evidence of Endocardial Involvement:
echocardiogram + for IE
Minor Criteria:
predisposition, predisposing heart condition or IVDA
fever (> 100.4 F)
vascular phenomena (major arterial emboli, ICH, Janeway lesions)
immunologic phenomena (Osler nodes, Roth spots, glomerulonephritis)
microbiologic evidence: positive blood culture but does not meet major criteria |
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Definition
| what are the major and minor Duke criteria for IE? |
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Term
DEFINITE IE:
2 major criteria
1 major criteria and 3 minor criteria
5 minor criteria
POSSIBLE IE:
1 major criteria and 1 minor criteria
3 minor criteria |
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Definition
| how are the Duke criteria used to diagnose IE? |
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Term
Penicillin G: 4 weeks
OR
Ceftriaxone: 4 weeks
Each +/-
Gentamicin: combination shortens total therapy to 2 weeks
OR
Vancomycin only (for severe allergy only): 4 weeks |
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Definition
| treatment and duration for IE caused by viridians streptococci MIC < 0.1 mcg/ml, NATIVE VALVE |
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Term
Penicillin G: 4 weeks
OR
Ceftriaxone: 4 weeks
EACH +
Gentamicin: 2 weeks
OR
Vancomycin only (for severe allergy only): 4 weeks |
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Definition
| treatment and duration for IE caused by Viridian Strep, PCN resistant, NATIVE VALVE |
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Term
Penicillin G: 6 weeks
OR
Ceftriaxone: 6 weeks
Each +/-
Gentamicin: 2 weeks
OR
Vancomycin only (for severe allergy only): 6 weeks |
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Definition
| treatment and duration for IE caused by Viridians Strep, MIC < 0.12, PROSTHETIC VALVE |
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Term
Penicillin G: 6 weeks
OR
Ceftriaxone: 6 weeks
EACH +
Gentamicin: 6 weeks
OR
Vancomycin only (for severe allergy only): 6 weeks |
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Definition
| treatment and duration for IE caused by Viridians Strep, MIC > 0.12, PROSTHETIC VALVE |
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Term
Nafcillin/Oxacillin: 6 weeks
OR
Cefazolin (only if non-anaphylactoid PCN allergy): 6 weeks
Each +/-
Gentamicin: 3-5 days
OR
Vancomycin only for MRSA: 6 weeks |
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Definition
| treatment and duration for IE caused by staphylococci, NATIVE VALVE |
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Term
Nafcillin/Oxacillin: >/= 6 weeks
AND
Rifampin: >/= 6 weeks
AND
Gentamicin: 2 weeks
OR
Vancomycin: >/= 6 weeks
AND
Rifampin: >/= 6 weeks
AND
Gentamicin: 2 weeks |
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Definition
| treatment and duration for IE caused by staphylococci, PROSTHETIC VALVE |
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Term
Ampicillin: 4-6 weeks
OR
Penicillin G: 4-6 weeks
OR
Vancomycin: 6 weeks
EACH +
Gentamicin: 4-6 weeks
OR
Streptomycin (if Gentamicin resistant): 4-6 weeks |
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Definition
| treatment and duration for IE caused by Enterococci, NATIVE OR PROSTHETIC VALVE |
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Term
Gentamicin increases the activity of cell wall agents by working in synergy
Gentamicin is concentration dependent
POST ANTIBIOTIC EFFECT: drug is still working even if levels are low |
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Definition
| what is the role of Gentamicin in IE treatment regimens and why might it be given once daily vs q8h? |
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