Infective Endocarditis

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Author:
alvo2234
ID:
252592
Filename:
Infective Endocarditis
Updated:
2013-12-11 13:52:18
Tags:
Dr Verheyden
Folders:
PT,IV,final
Description:
final
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  1. what are the major criteria for IE
    • positive blood culture (2 separate cultures)
    • endocardial evidence (TTE, TEE)
  2. what are the minor criteria for IE
    • predisposition
    • fever > 38
    • vascular phenomena
    • immunologic phenomena 
    • microbiologic evidence
  3. what is the clinical criteria needed to dx a pt with IE
    • 2 major
    • 1 major + 3 minor
    • 5 minor
  4. what are the 3 major bacterial causes of IE
    • staph
    • strep
    • enterococcus
  5. what are the HACEK organisms
    • haemophilus aphrophilus
    • actinobacillus actinomycetemcomitans
    • cardiobacterium hominis
    • eikenella corrodens 
    • kingella kingae
  6. what are the gram negative pathogens associated with IE and what % do they make up
    • 2%
    • k. pneumoniae
    • p. aeruginosa
    • e. coli
  7. what are the bacterial resisitant staph
    • MRSA
    • VISA (intermediate)
    • VRSA
  8. streptococcus resistance to macrolides
    • methylation
    • efflux pump
  9. e. faecalis and faecium are relatively resistanct to which drugs and must be combined with which drug
    • penicillin, ampicillin, vancomycin
    • combine with AG
  10. infection with Strep bovis should prompt which type of investigation
    colonoscopy
  11. strep is usually not associated with which users
    IV drug users
  12. Tx for strep and s.bovis
    • penicillin or ceftriaxone for        4wks
    • pen/ceftriaxone + gentamicin    2wks
    • vancomycin (b-lac allergy)         4 wks
  13. Tx of IE in viridans strep and s. bovis pts with prosthetic valve
    • penicillin, ceftriaxone             6wks
    • gentamicin                           2 wks
    • vancomycin                           6 wks
  14. Tx of viridans strep and s. bovis in prosthetic valve pts with relative or full resistant strains
    • penicillin 2-6 mill units           6wks
    • ceftriaxone 2g q 24 hrs           6 wks
    • +gentamicin                          6 wks
    • vancomycin 15mg q 12hrs        6 weeks
  15. what is the most common cause of prosthetic valve IE
    coagulase negative staphylococcus
  16. which CoNS has the higher rates of metastatic infection
    s. lugdenensis
  17. infected sides and mortality/cure rates in addict/non-addict pts with s. aureus
    • left side more common in non addicts
    •        (20-40% mortality)
    • right side (tricuspid) in IV drug use
    •        (85% cure rate)
  18. Tx for native valve IE caused by staphylococcus
    • nafcillin or oxacillin (2g q4-6)      6wks
    • +- gentamicin (1mg/kg q8 hrs)    3-5 days
    • or (penicillin allergy)
    • Cefazolin (2g q8 hrs)                  6 wks
    • +-gentamicin                            3-5 days
    • or (MRSA)
    • vanco (15mg/kg q12hrs)             6wks
  19. Tx for prosthetic valve IE caused by staphlococcus
    • naf/oxacillin (2g q4-6hrs)      >=6wks
    • plus rifampin (300 mg q8)     >=6wks
    • plus gentamicin (1mg/kg q8)      2wks
    • or (MRSA)
    • vancomycin
    • rifampin
    • gentamicin
  20. SAR for ceftaroline that acts against MRSA activity
    1,3 thiazole ring
  21. tx for native or prosthetic valve IE caused by enterococcus
    • penicillin or ampicillin + gentimicin       4-6wks
    • or (b-lactam allergy)
    • vancomycin + gentamicin                    6 wks
  22. which agent is used in IE enterococcus strains resistant to gentamicin
    streptomycin along with pen/ampicillin
  23. which agents are used in IE enterococcus which is resistant to pen, AG, vanco
    ceftriaxone + ampicillin for 8 wks

    • linexolid or synercid
    • imipenem cilastin + ampicillin

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