Id 4 - Endocarditis And Bsi

Front 1

Marantic endocarditis

Back 1

From cancer and other debiliating diseases

Front 2

Libman-Sacks endocarditis

Back 2

Associated with SLE

Front 3

Infectious endocarditis - characteristics

Back 3

Microbial infection of endocardial surface of the heart
Characteristic valvular vegetation

Front 4

Risk factors for IE

Back 4

Old age
More implantable devices
2:1 male predominance

Front 5

Organisms in subacute IE

Back 5

Strep viridans
Less virulent organisms

Front 6

Time course of subacute IE

Back 6

3 weeks to 6 months

Front 7

Organisms in acute IE

Back 7

Staph aureus
Pneumococcus
Group A strep

Front 8

Time course of acute IE

Back 8

Days to weeks

Front 9

Time course of chronic IE

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6 months

Front 10

Clinical classifications of IE

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IV drug user
Native valve
Prosthetic valve
Nosocomial

Front 11

Pathophysiology of IE

Back 11

Damage to native valve via lesions, valve problems, or congenital heart disease
Abnormal turbulent flow
Localized damage to endothelium and fibrin clot formation
Infection of fibrin clot and growth of vegetation

Front 12

Valves involved in IE

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Mostly left-sided - aortic and mitral
Right-sided in IVDU

Front 13

Organisms in native valve IE

Back 13

Staph aureus
Oral strep in subacute cases

Front 14

Organisms in IVDU IE

Back 14

Staph aureus

Front 15

Organisms in prosthetic valve IE

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Early - associated with surgery, coag-negative staph and skin flora
Late - oral streptococci due to endothelialization of valve

Front 16

Organisms in culture-negative IE

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HACEK organisms

Front 17

HACEK organisms

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Haemophilus species
Actinobacillus actinomycetemcomitans
Cardiobacterium hominis
Eikenella corrodens
Kingella kingae

Front 18

Fever
Chills
Arthralgias and myalgias
Malaise
Weight loss

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Clinical presentation of IE

Front 19

Cardiac murmur
Splenomegaly
Peripheral lesions - Osler nodes, splinter hemorrhages, Janeway lesions, Roth spots, petechiae

Back 19

Common signs of IE

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Osler nodes

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Autoimmune vasculitis
Tender subcutaneous nodules in pulp or digits of thenar eminence

Front 21

Splinter hemorrhages

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Hemorrhages under fingernails and toenails

Front 22

Janeway lesions

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Vasculitic or thrombotic
Nontender red hemorrhagic pustules on palms or soles

Front 23

Roth spots

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Embolic or autoimmune
Retinal lesions

Front 24

Petechiae

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Embolic or autoimmune
Small hemorrhages on conjunctiva, buccal mucosa, palate, or extremities

Front 25

Embolic complications of IE

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Stroke
Brain abscess
Splenic lesions
Lung abscess in right-sided
Autoimmune glomerulonephritis with renal failure

Front 26

Diagnosis

Back 26

Blood cultures before drawing antibiotics
Duke criteria

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Major Duke criteria

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Positive culture with typical organism or persistently positive
Evidence of endocardial involvement - new valvular regurgitation, echo with periannular abscess, intracardiac mass, new dehiscence of prosthetic valve

Front 28

Echocardiogram for IE

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Transthoracic is less invasive - always do first
Transesophageal is more sensitive

Front 29

Minor Duke criteria

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Predisposition - heart condition or IVDU
Fever
Immunologic phenomena - Osler nodes, Roth spots, glomerulonephritis
Vascular phenomena - Janeway lesions, petechiae
Blood cultures not meeting major criteria

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Treatment of IE

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Penicillins and cephalosporins for non-beta lactamase staph

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Empiric therapy for IE

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Vancomycin

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Therapy for enterococci or coag-negative staph

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Penicillin with aminoglycoside (gentamicin)

Front 33

Duration of IE treatment

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4-6 weeks
6 weeks for prosthetic valve

Front 34

Treatment for right-sided IE

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2 weeks oxacillin and gentamicin

Front 35

Indications for surgery in IE

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Refractory heart failure from valve insufficiency
Persistent sepsis
Persistent embolization
Valve ring or myocardial abscess

Front 36

Indications for prophylaxis

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Prosthetic valve
Previous IE
Heart transplant with valvulopathy
Unrepaired cyanotic heart disease
Invasive respiratory or skin and soft tissue procedures

Front 37

Prophylaxis for gingival dental procedures

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PO amoxacillin
Aminoglycoside if allergic to penicillin

Front 38

Classification of catheter-associated BSI

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Primary - no clear source
Secondary - other source identified from culture or exam
Transient - acute infection or after manipulation of non-sterile mucosal surface

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Sources of catheter infection

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Bacteria growing on cathether
Infected hub
Infected infusate
Extrinsic organisms through exit site

Front 40

Diagnosis of catheter-associated BSI

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Positive blood culture with pathogenic organism with no infection elsewhere

Front 41

Complications of BSI

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Endocarditis
Osteomyelitis
Endophthalmitis
Septic arthritis
Septic pulmonary emboli
Systemic abscess

Front 42

Treatment of catheter-associated BSI

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Remove catheter
Evaluate for disseminated infection
Treat for 2 weeks if not disseminated

Front 43

Prevention of cathether-associated BSI

Back 43

Avoid tunneled CV catheters long-term if possible
Subclavian or jugular vein least likely infected
Sterile barrier precautions
Sterilize catheter and hub