Endocarditis

The flashcards below were created by user ebmalonzo on FreezingBlue Flashcards.

  1. Endocarditis Common Microorganisms
    • Staphylococci
    • • Staphylococcus aureus
    • → Most common cause of infective endocarditis
    • → Common in IVDUs
    • • Coagulase‐negative Staphylococcus
    • → Most common cause of early prosthetic valve endocarditis
    • Streptococci
    • • Common cause of community‐acquired, native valve endocarditis in non‐IVDUs with underlying cardiac abnormalities
    • • Viridans streptococci (S. sanguis, S. mutans, S. mitis, S. salivarius, etc.)
    • → May follow dental procedures
    • • Streptococcus bovis
    • → Often associated with colonic lesion/malignancy
    • Enterococci
    • • May follow GI or GU procedures
    • • Enterococcus faecalis
    • • Enterococcus faecium
  2. Endocarditis HAECK Microorganisms
    • • Haemophilus species (H. parainfluenzae, H. aphrophilus, H. paraphrophilus)
    • • Aggregatibacter (formerly Actinobacillus) actinomycetemcomitans
    • • Eikenella corrodens
    • • Cardiobacterium hominis
    • • Kingella kingae
  3. Streptoccoccal Endocarditis (PCN susceptible; MIC ≤0.12): Native Valve (4 wk preferred)
    • • PCN G 12‐18 mu/day IV divided q4h
    • • Ceftriaxone 2 g IV q24h
    • • Preferred in elderly and pts w/renal impairment
  4. Streptoccoccal Endocarditis (PCN susceptible; MIC ≤0.12): Native Valve (2 wk preferred)
    • • Penicillin G + gentamicin
    • • Ceftriaxone + gentamicin
    • • Pts w/out cardiac or extracardiac abscesses, CrCl ≥20
  5. Streptoccoccal Endocarditis (PCN susceptible; MIC ≤0.12): Native Valve (alternative)
    Vancomycin x4 wks (trough 15-20 mcg/mL)
  6. Streptoccoccal Endocarditis (PCN susceptible; MIC ≤0.12): Prosthetic Valve (preferred)
    • • PCN G 24 million units/day IV divided q4h x6 wks ± gentamicin x2 wks
    • • Ceftriaxone x6 wks ± gentamicin x2 wks
  7. Streptoccoccal Endocarditis (PCN susceptible; MIC ≤0.12): Prosthetic Valve (alternative)
    Vancomycin x6 wks
  8. Streptoccoccal Endocarditis (PCN resistant; MIC >0.12, ≤0.5): Native Valve (preferred)
    • • PCN G 24 mu/day IV divided q4h x4 wks + gentamicin x2 wks
    • • Ceftriaxone 2 g IV Q24H x4 wks + gentamicin x2 wks
  9. Streptoccoccal Endocarditis (PCN resistant; MIC >0.12, ≤0.5): Native Valve (alternative)
    Vancomycin x4 wks
  10. Streptoccoccal Endocarditis (PCN resistant; MIC >0.12, ≤0.5): Prosthetic Valve (preferred)
    • • PCN G 24 mu/day + gentamicin x6 wks
    • • Ceftriaxone + gentamicin x6 wks
  11. Streptoccoccal Endocarditis (PCN resistant; MIC >0.12, ≤0.5): Prosthetic Valve (alternative)
    Vancomycin x6 wks
  12. Streptoccoccal Endocarditis (Fully PCN resistant; MIC >0.5)
    See Enterococcal Endocarditis Tx
  13. Enterococcal Endocarditis (Preferred)
    • • Ampicillin 2 grams IV Q4H + gentamicin
    • • PCN G 18‐30 million units/day IV either continuously or divided Q4H + gentamicin
    • • Native valve
    • → S/x ≤ 3 months- 4 wks
    • → S/x >3 months- 6 wks
    • • Prosthetic valve- 6 wks
  14. Enterococcal Endocarditis (Alternative)
    • • Vancomycin + gentamicin x6 wks
    • • If resistant to gentamicin: substitute streptomycin
    • • If β‐lactamase producing strain: use ampicillin‐sulbactam or vancomycin + gentamicin
  15. Staphylococcal Endocarditis (β‐lactam Susceptible): Native valve (Preferred)
    • • Usually MSSA
    • • Nafcillin/oxacillin 12 grams/day IV divided q4h x6 wks ± gentamicin x3‐5 days
  16. Staphylococcal Endocarditis (β‐lactam Susceptible): Native valve (Alternative)
    • • Usually MSSA
    • • Cefazolin 2 grams IV q8h x6 wks ± gentamicin x3‐5 days
    • • Vancomycin x6 wks ± gentamicin x3‐5 days
  17. Staphylococcal Endocarditis (β‐lactam Susceptible): Prosthetic valve (Preferred)
    • • Likely MSSA
    • • Nafcillin/oxacillin x≥6 wks + rifampin 300 mg IV/PO TID x≥6 wks + gentamicin x2 wks
  18. Staphylococcal Endocarditis (β‐lactam Susceptible): Prosthetic valve (Alternative)
    • • Likely MSSA
    • • Cefazolin x≥ 6 wks + rifampin x≥6 weeks + gentamicin x2 wks
    • • Vancomycin x≥ 6 wks + rifampin x≥6 weeks + gentamicin x2 wks
  19. Staphylococcal Endocarditis (β‐lactam Resistant): Native valve
    • • Usually MRSA, also MRSE
    • • Vancomycin x6 wks ± gentamicin x3‐5 days
  20. Staphylococcal Endocarditis (β‐lactam Resistant): Prosthetic Valve
    • • Often MRSE, also MRSA
    • • Vancomycin x≥6 wks + rifampin x≥6 wks + gentamicin x2 wks
  21. IVDU with Staphylococcal Endocarditis
    • • Nafcillin/oxacillin + gentamicin x 2 wks
    • • Only for uncomplicated right‐sided endocarditis due to MSSA
  22. HAECK Endocarditis
    • • Ceftriaxone 2g q24h
    • • Ampicillin/sulbactam 12g/q24h divided in 4 doses
Author:
ebmalonzo
ID:
316195
Card Set:
Endocarditis
Updated:
2016-02-20 22:30:19
Tags:
Endocarditis
Folders:
ID 1
Description:
ID 1 (Final): Endocarditis
Show Answers: