thera final infective endocarditis

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coal
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272569
Filename:
thera final infective endocarditis
Updated:
2014-05-02 11:48:13
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thera final infective endocarditis
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thera final infective endocarditis
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thera final infective endocarditis
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  1. empiric Tx for acute native valve (Non IVDU)
    nafcillin or oxacillin + gentamicin
  2. empiric Tx for acute native valve (IVDU)
    vancomycin + gentamicin
  3. empiric Tx for subacute native valve
    ampicillin/subactam + gentamicin
  4. treatment for native valve streptococcus
    • Pen G 12-24 million units (ceftriaxone)  4wks
    • +
    • gentamicin                                           2wks
  5. treatment for prosthetic valve streptococcu
    • Pen G 24 million/units (ceftriaxone)        6 wks
    • +
    • gentamicin                                            2 wks
  6. treatment of native valve MSSA
    • nafcillin/oxcillin or cefazolin                    6 wks
    • +
    • gentamicin                                         3-5 days
  7. treatment of prosthetic MSSA
    • nafcillin/oxcillin                        > 6 wks
    • +
    • rifampin
    • +
    • gentamicin                                   2 wks
  8. treatment of native MRSA
    • vancomycin                                     6 wks
    • or
    • daptomycin                                     6 wks
  9. treatment of prosthetic MRSA
    • vancomycin                                     > 6 wks
    • +
    • rifampin
    • +
    • gentamicin                                         2 wks
  10. duke major criteria
    • 2 separate + cultures
    • evidence of endocardial involvement
    •   new valve regurgitation
    •   identified vegetation
    •   abscess
    •   dehiscence of prosthetic valve
  11. duke minor criteria
    • fever > 38
    • evidence of embolism
    • immunological problems
    • predisposing factors
    • positive blood culture
  12. treatment of enterococcus (native or prosthetic)
    ampicillin/vancomycin + gentamicin   4-6wks
  13. treatment of HACEK organisms
    • ceftriaxone                                           4 wks
    • or
    • ampicillin-sulbactam
    • or
    • cipro
  14. indications of antimicrobial prophylaxis IE
    • previous infective endocarditis
    • prosthetic cardiac valve/material
    • congenital heart disease
    • cardiac vavulopathy after cardiac transplant
  15. dental regimen oral
    amoxicillin
  16. dental regimen if unable to take oral
    • ampicillin
    • or
    • cefazolin or ceftriaxone
  17. dental regimen if allergic to penicillins
    • cephalexin
    • or
    • clinda
    • or
    • azithro
  18. dental regimen allergic to penicillins and unable to take oral med
    • cefazolin
    • or
    • ceftriaxone
    • or
    • clindamycine
  19. risk factors for IE
    • previous endocarditis
    • valvular disease
    •   mitral
    •   aortic
    • congenital heart disease
    • rheumatic heart disease
    • prosthetic valve

    chronic IV access

    • DM
    • HIV
    • healthcare exposure
  20. pathogens that cause IE
    • staphylococcus aureus 31%
    • viridians streptococci 17%
    • CON staphylococci 11%
    • enterococci 11%
  21. early vs late infection
    early = w/I 2 months of valve replacement, generally due to intraoperative contamination or post operative infection

    late = > 12 mo after placement of prosthesis, microbes and sites of entry similar to native valve
  22. nosocomial infection
    • new diagnosis of IE 3-60 days after hospital admission
    • risk of bacteremia
    • often higher mortality rate
  23. clinical presentation
    • sepsis criteria
    •   temp > 38
    •   WBC > 12,000
    •   HR > 90bpm
    •   RR > 20
    • New heart murmurs
  24. physical clinical presentations
    • clubbing
    • janeway lesions - palm
    • osler nodes - fingers
    • petechiae - body
    • splinter hemorrhages - nails
    • roth spots - eyes
    • emboli
  25. beta lactam coverages
    • nafcillin - staphylococcal
    • pen G - streptococcal
    • ampicillin - enterococcal
  26. empiric treatment if PCN allergic
    • vano common
    • cephalosporin or carbapenem consideration
  27. 4 indication of antimicrobial prophylaxis
    • previous infective endocarditis
    • prosthetic cardiac valve/material
    • congenital heart disease
    • cardiac valvuopathy after cardiac transplant

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