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IOS 10 exam 4

Endocarditis

QuestionAnswer
High Risks for Endocarditis are 1. Prosthetic valvues- porcine or St. Judes2. Rheumatic heart disease, 3. Cyanotic congenital heart disease, 4. History of previous endocarditis, 5. Non-valvular intracardiac prostheses
Moderate riskfor Endocarditis are 1. Mitrial valve prolapse or valvular regurgitation, 2. Congenetial bicuspid aortic valve, 3. Central IV lines-right atrium-TPN patient
What are the most common Valves Involved Mitral most common- 28-45% - Lower pressure flow has an increase of risk, Tricuspid- (0-6%) IVDA
Pathogenesis of Endocarditis Non-thrombotic endocarditis -Endothelial damage due to trauma - leads to fibrin and platelet deposition. The body tries to correct the “wound” and this creates an excellent growing environmentNon-bacterial thrombotic endocarditis (NBTE).
Microbes of endocarditis are 1. Viridans Streptococci- (Gram +, cocci chains ) most common 30-40%,2. Staph aureus- (Gram + ) IVDA, 3. Staph Epidermis- (Gram+), 4. Enterococci-E. faecalis, E. faecium, HACEK-
Viridans Streptococci-characteristics Gram +, cocci chains ) most common 30-40%- Called Native valve endocarditis. Produces dextran a sticky substance enables adherence to NBTE, Rarely effects normal valves.Treatment: MIC > 0.1mcg/mL, intermediate <0.5mcg/ml
Viridans Streptococci-treatment Long course- PCN G IV x 4 weeks 12 million QD in divided or Ceftriaxone 2g 4-6 wks + gentamycin or PCN All= Vancomycin IV 4 weeks orShort Course(low risk) - PCN G IV x 2 weeks 18 million QD in divided or Ceftriaxone 2g x 2 wks + gentamycin
Staph aureus- characteristics and treatment Gram + ) IVDA- Virulent organism more often effects the tricuspid valve.Treatment:Nafcillin 2g IV q4 hrx 4-6 weeks + / - gentamycin 1mg/kg Q8hr x 3-5 days or Cefazolin IV x 4 -6 weeks+/ - gentamycin
Staph Epidermis- characteristics and treatment (Gram+) Less virulent, rarely effects normal valvesMRSE: vancomycin 1gIV Q12monitor trough15-20x 6 weeks + Rifampin PO x>6 weeks + gentamicin 1mg/kg Q8 hrs, MSSE: Nacfilin IV x 6> 6 weeks +Rifampin PO x >6 weeks + gentamicin IV x 2 weeks
4. Enterococci-E. faecalis, E. faecium characteristics and treatment (Gram+) Normally a gut bacteria or skin bacteria. IVDA & GU. Treatment: Ampicillin IV 2 million units q4hr + 1mg/kg gentamycin q8hr for 4-6 weeks or Vancomycin 1g q 12hr and level directed with normal renal function.
HACEK-Characteristics and treatment Gram – bacilli or cocibacilli) Haemophilus, Actinobacillus, Cardiobacterium, Eikenella corrodens, Kingella KinaeTreatment: Ceftriaxone 2 g IV Q24 x 4 (naïve) or 6 weeks if prosthetic valve PCN all- Bactrim or Fluoroquinolones
Fungi- Characteristics and treatment Immunocompromised, IVDA, patients with chronic indwellin IV linesTreatment: Amphotercin 0.5-1mg/kg for a cumulative dose of 2 grams
If Empiric therapy DOC Vancomycin IV
Complications of endocarditis Septic Emboli- Large vegetation,Right sided lesion- Left-sided lesion- Organ dysfunction- Janeway lesions (Plantar of foot) Splinter hemmoraha Immune Complex deposition-Petechiae- Small Ring Abscesses- Biofilms attaches Valvular destruction- lead
Duke Criteria-Dx based on Definitive 2 major or 1 major and 3 minor or 5 minor= treatment
Major-Duke Criteria Positive for infective endocarditis (2)- 2. positive blood culture from Blood cultures > 12 hrs apart 3. Posive ECHO for IE
Minor-Duke Criteria IVDU or CHD, aneurysm, janeway lesion, oslers nodes, (+ culture but not evidence) or echo but not criteria
Endocarditis Prophylaxis:Dental/oral/URTi Dental/oral/URTi- Amoxicillin 2 g PO 1 hr prior to procedure or PCN allergy Azithromycin/clarithromycin
Endocarditis Prophylaxis:GI/Gu procedure Ampicillin 2g IV + gentamicin 1.5mg/kg 30 minutes prior to procedure, IF PCN ALL- Vancomycin 1 g IV + gentamycin 1.5mg/kg 1 hour prior.a. High risk additional dose 6 hours later.b. Low risk Ampicillin 2mg PO prior procedure
Created by: liza001
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