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Cardiology - ABIM
Endocarditis
Question | Answer |
---|---|
Seven indications for surgery in patients with native valve infective endocarditis | BBEHAVE: persistent Bacteremia 5-7 d on abx, heart Block, recurrent Emboli, Heart failure 2/2 valve dysfunction, valve Abscess, mobile Vegetation >10mm, left sided Endocarditis 2/2 resistant organisms such as MRSA, fungal, etc |
Which high risk procedures should get endocarditis prophylaxis? | Dental procedures that have risk of bleeding. |
Which high-risk conditions should get prophylaxis for endocarditis? | Prophylax The Cute Heart. Prosthetics (valve, patch); Transplant; Congenital heart disease with repair in the last 6 mo; History of endocarditis. |
List the conditions that would not warrant endocarditis prophylaxis. (5) | s/p CABG, pacemaker, ASD/VSD, HOCM, |
Antibiotic for endocarditis prophylaxis – general. When should it be given? | Amoxicillin by mouth given one hour prior to procedure. |
Antibiotic for endocarditis prophylaxis if the patient is NPO. | IV ampicillin given one hour prior to procedure. |
Antibiotic for endocarditis prophylaxis if the patient has a penicillin allergy. | Azithromycin PO, given one hour prior to procedure |
What antibiotic is given after a procedure if the patient got pre procedure endocarditis prophylaxis? | Nothing after the procedure. |
empiric therapy for native valve endocarditis | Vancomycin and gentamicin |
empiric therapy for endocarditis in a patient with IV drug usage | Vancomycin and gentamicin |
Antibiotic for MRSA endocarditis | Vancomycin |
antibiotic for MSSA endocarditis | Ceftriaxone |
Antibiotic for Streptococcus endocarditis | Ceftriaxone |
Antibiotic for Streptococcus endocarditis if the patient is penicillin resistant | Ceftriaxone and gentamicin |
Empiric antibiotic therapy for endocarditis in a patient with prosthetic cardiac valve | Rifampin plus vancomycin plus gentamicin |
Antibiotic for MRSA endocarditis in a patient with prosthetic cardiac valve | Rifampin plus vancomycin plus gentamicin |
Antibiotic for MSSA endocarditis in a patient with prosthetic cardiac valve | Rifampin plus ceftriaxone plus gentamicin |
Antibiotic for Strep endocarditis in a patient with prosthetic cardiac valve | Ceftriaxone |
Antibiotic for Strep endocarditis in a patient with prosthetic cardiac valve and has penicillin resistance | Ceftriaxone and gentamicin |
medication for right-sided endocarditis with septic emboli | Daptomycin |
If the patient has staph aureus bacteremia, what studies should you do? | Do a transesophageal echocardiogram to rule out endocarditis |
How long do you treat Staph aureus bacteremia in the general population? | Two weeks if blood cultures become negative in less than 72 hours after start of antibiotics. |
For which populations would you treat Staph aureus bacteremia for four weeks? | Patients that have positive blood cultures for greater than 72 hours after starting antibiotics; immunocompromised patients; patients with cardiac prosthetic valves; patients with prosthetic joints |
If a patient has a prosthetic valve and staph aureus bacteremia, what should you do for the patient? | Remove the prosthetic valve |
For which population would you treat staph aureus bacteremia for 6 to 8 weeks? | Patients who have a positive transesophageal echocardiogram, denoting that they have endocarditis. |