Term
| What are different types of endocarditis? |
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Definition
- Acute - fulminating form, develops suddenly. Usually S. aureus
- Subacute - Indolent, slow growing. Preexisting valvular disease. Usually S. viridans.
- Prosthetic valve - following insertion
- Right sided - seen in IV drug users
- Left sided - more common than right and severe. Mitral valve
- Native valve - Mt
- Culture negative - improper draw or fastidious organism |
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Term
| What pathogens cause infective endocarditis? |
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Definition
- Primarily S. aureus, sometimes Staph viridans. Very rarely enterococci
**More males:females, in older patients and IVDA, diabetes, dialysis, dental |
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Term
| What valves are affected in endocarditis in drug users? |
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Definition
Tricuspid > aortic > mitral
- Mostly S. aureus. Mostly young men --> tx w/ Nafcillin or vanc
**Normal: Mitral and Aortic |
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Term
| What are risk factors for endocarditis? |
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Definition
- Presence of prosthetic heart valve
- Previous endocarditis
- Diabetes
- IVDA |
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Term
| What is the pathogenesis of endocarditis? |
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Definition
| A heart defect leads to pressure gradients --> fibrin platelet deposition --> bacteria colonize these clots, esp. those w/ adherins (gram+) --> vegetation |
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Term
| What are vegetations in endocarditis? |
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Definition
Bacteria colonization - destroys valvular tissue, leading to perforation
**Emboli affect organs with HIGH blood flow: Kidneys, spleen, brain |
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Term
| What is the clinical presentation of the 2 types of endocarditis? |
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Definition
- Non-virulent = Strep viridans: Low fever, malaise, fatigue, weight loss
- Virulent = S. aureus: High fever, chills, sweats, septic
**Heart murmur, Enlarged spleen, Osler nodes (edemedous fingers), Janeway lesions on feet, splinter hemorrhage on nails, Petechiae, clubbing of fingers, roth spots (retinal infarction), emboli on toes |
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Term
| What lab finding is indicative of endocarditis? |
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Definition
- Blood culture! x3 from different venous punctures
- Also incr ESR and CRP
- Echo: TTE or TEE (for high risk, more specific) |
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Term
| What is the duke criteria definition of endocarditis? |
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Definition
- Major - 2 separate + BCs, persistent + BC, BC + for C. burnetti or IgG, positive echo, new valvular regurgitation
- Minor - predisposing heart condition, Fever > 38/100.4, vascular/immune phenomena, micro evidence
**2 major, 1 major + 3 minor, or 5 minor = DEFINITE
**1 major + 1 minor, or 3 minor = POSSIBLE |
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Term
| What are complications from endocarditis? |
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Definition
- CHF - most common
- Embolism
- Aneurysm
- Glomerulonephritis
- Resistant organism = relapse |
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Term
| How is endocarditis in a native valve treated? |
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Definition
- PCN - PCN or ceftriaxone w/ or w/o gent. NAFCILLIN or Vanc/Dapto
- PCN intermediate - higher dose X4 weeks, have to use gent
- PCN resistant - w/ regimen for enterococcal endocarditis
- PCN allergy: Vanc
**never use extended dosing AGs |
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Term
| How is tx for prosthetic valve endocarditis different? |
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Definition
- MSSA: Nafcillin + rifampin + gent
- MRSA: Vanc + rifampin + gent
**Incr in nephrotoxicity, must monitor patient.
**Daptomycin also approved, not better than Vanc |
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Term
| How is enterococcal endocarditis treated? |
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Definition
- PCN susceptible - PCN + gent/streptomycin if gent resistant
- PCN allergic - Vanc + gent
- PCN resistant - Also Vanc + gent
- Vanc resistant: E. faecium (Linezolid or synercid), E. faecalis (Imipenem + ampicillin OR ceftriaxone) |
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Term
| What is HACEK endocarditis? |
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Definition
H - H. parainfluenzae
A - Actinobacillus actinomycetemcomitans
C - Cardiobacterium hominis
E - Eikenella corrodens
K - Kingella kingae
Rare gram(-), do not normally adhere. Tx w/ ceftriaxone 2g q24h or Cipro in a PCN allergy |
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Term
| How is gram(-) endocarditis treated? |
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Definition
- P. aerug - Piperacillin/Ceftazidime/Cefepime + Tobra
- E. coli - Ampicillin or PCN or broad spec cef + AG |
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Term
| How is fungal endocarditis treated? |
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Definition
Rare, seed in IVDA and the immune compromised. Candida or aspergillus
Tx ONLY with amphotericin B |
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Term
| When is surgery needed for endocarditis? |
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Definition
- Persistent vegetation
- Valve dysfunction
- Evidence of failure |
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Term
| When can FQNs be used for endocarditis? |
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Definition
| Only when Staph is Oxacillin susceptible. |
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Term
| When should dental procedures be prophylaxed for endocarditis? |
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Definition
- Prosthetic heart valve
- Previous endocarditis
- Congenital heart disease
- Cardiac transplant
**Amox 2g or equivalent |
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