Term
| Inc sed rate and inc CRP indicate>>> |
|
Definition
| Non specific inflammation somewher in body |
|
|
Term
| Infective endocarditis (IE) |
|
Definition
| inflamed inner lining of hrt chambers/valves w/ infxn etiology |
|
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Term
|
Definition
|
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Term
|
Definition
|
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Term
|
Definition
-Lesion location:left/right sided
-Native valve: valve you were born with
-Prosthetic valve: surgically placed
-Healthcare,community, Intravenous drug use
-Device related:pacemaker |
|
|
Term
| Which Valve is most cases |
|
Definition
|
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Term
|
Definition
|
|
Term
| Highest mortality in Endocarditis |
|
Definition
| Healthcare associated endocarditis (40%) |
|
|
Term
| Valve most affected in IV drug users |
|
Definition
| Tricuspid valve (right sided) |
|
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Term
|
Definition
Non bacterial thrombotic endocarditis
-restricts normal blood flow. bacteria settle in low pressure area |
|
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Term
|
Definition
| Vegetation: platelt fibrin complex. bacteria settle and are impervious to immune response |
|
|
Term
| vegetation not seen in ______ of pts |
|
Definition
|
|
Term
| Organism most causing endocarditis |
|
Definition
|
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Term
|
Definition
| Staph. Aureus, Viridans strep, strep bovis,enterococci |
|
|
Term
|
Definition
FEVER, HEART MURMER (new, or worsened)
-chills
-Arterial emboli
-embolic/immune complexes
-myalgia |
|
|
Term
|
Definition
-Musculoskeletal: pain myalgia
Resp:Dyspnea, tachycardia
Embolic: chest CT showing pulmonary Septic emboli |
|
|
Term
|
Definition
unexplained persistently + blood culture
-blood culture + 72 hrs after catheter removed
-embolism/sepsis of unknown origin |
|
|
Term
|
Definition
-2 separate cultures of orgs known to cause IE
-at least 2 cultures >12 hrs apart
-all3 or majority >/= 4 sep cultures drawn w/ in 1 hr
-single pos cult of >1:8000 for coxiella burnettii |
|
|
Term
| Major Criteria:Evidence of endocardial involved |
|
Definition
+ echo for IE
New valvular regurg |
|
|
Term
|
Definition
fever
hrt condtn
immun phenomena
vascular phenomena
Microbio evidence |
|
|
Term
|
Definition
2 major no minor
1 major 3 minor
no major 5 minor |
|
|
Term
|
Definition
1 major 1 minor
no major 3 minor |
|
|
Term
| common indications for surgery in IE |
|
Definition
-CHF -Embolic complications
-vegetation size
-PVE -ABscess
-Refractory sepsis |
|
|
Term
| Need how man yblood cultures every 24-48 hours |
|
Definition
| 2 blood cultures until clearance of bacteremia |
|
|
Term
| NVE and right sided IE TX is________ Than PVE |
|
Definition
|
|
Term
| resected tissue positive? |
|
Definition
| entire course of Tx occurs after Valve resection |
|
|
Term
| resected tissue Negative? |
|
Definition
| duration of Therapy is PVE duration counting days of Tx prior to surgery |
|
|
Term
NVE Viridans/Bovis Tx
</= 0.12 mcg/ml 4 week regimen |
|
Definition
| Penicillin G or Ceftriaxone or Vanco (for confirmed lactam allergy) |
|
|
Term
NVE Viridans/Bovis Tx
</= 0.12 mcg/ml 2 week regimen |
|
Definition
Penicillin G
or
Ceftriaxone + Gentamicin |
|
|
Term
Exclusion for Penicillin 2 week Regimen
NVE Viridans/Bovis Tx
</= 0.12 mcg/ml 2 week regimen |
|
Definition
extracardiac disease abscess
CrCl <20ml/min PCN tolerant organism |
|
|
Term
NVE Viridans/Bovis Tx
PCN MIC 0.12-0.5 mcg/ml |
|
Definition
| Pen G 4wks + Gentamicin 2 wks or Ceftri Monotx (SVERE PEN ALLRGY) or Vanco Monotx(SVERE PEN ALLRGY) |
|
|
Term
NVE Viridans/Bovis Tx
PCN mic >0.5 mcg/ml Nutritionally variant strep |
|
Definition
| Pen G + Gentamicin (4-6 weeks) or Vanco Monotx (SVERE PEN ALLRGY)(4-6 weeks) |
|
|
Term
PVE Viridans/Bovis Tx
PCN susceptible MIC </= 0.12 |
|
Definition
| Pen G (6 weeks) or Ceftri (6 wks) +/- Gentamicin (2wks) or Vanco Monotx (6wks) |
|
|
Term
PVE Viridans/Bovis Tx
PCN susceptible/or fully resistant strain MIC > 0.12 |
|
Definition
| Pen G (6 weeks) or Ceftri (6 wks) + Gentamicin (6wks) or Vanco Monotx (6 wks) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
Vanco goal trough
(FOR STAPH NVE & PVE?) |
|
Definition
10-20mcg/ml
FOR STAPH NVE & PVE:15-20mcg/ml |
|
|
Term
| Enterococcus Tx Pen/Gent susceptible strains |
|
Definition
| Penicillin or Ampicillin + Gentamicin |
|
|
Term
Enterococcus Tx
Pen/Gent susceptible strains DURATION |
|
Definition
NVE & Sx <3 mnths: 4wks
PVE or Sx >3mnths: >/=6wks |
|
|
Term
Enterococcus Tx
Pen allergic or intrinsic pen resistance |
|
Definition
Vanco + Gentamicin
6 weeks |
|
|
Term
| E Faecalis IE CrCl <50 ml/min |
|
Definition
Ampicillin 2gm IV q 4 h + Ceftri 2gm q 12 h(high dose)
6 weeks |
|
|
Term
| Cephalasporins activity on ENTEROCOCCI |
|
Definition
| No activity on enterococci alone |
|
|
Term
|
Definition
Streptomycin: ototoxic
Amp-Ceftri: 6 weeks (low risk nephrotoxicity) |
|
|
Term
| Streptomycin: Avoid in CrCL |
|
Definition
|
|
Term
| B-lactamase producing strains or severe vanco allergy |
|
Definition
Amp-sulbactam + Gentamicin
6 weeks |
|
|
Term
|
Definition
Linezolid 600mgIV/PO q12 h
Daptomycin 10-12 mg/kg q24h + amp or ceftaroline
>6 weeks duration |
|
|
Term
|
Definition
bone marrow suppression (Thrombocytopenia)
neuropathy
DDI (SSRIs) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| CPK at baseline and weekly |
|
|
Term
|
Definition
|
|
Term
| Higher mortality of Staph IE in |
|
Definition
|
|
Term
|
Definition
|
|
Term
| NVE: Staph spp Tx (methicillin susceptible) |
|
Definition
Nafcillin or Oxcacillin 12g/24 h in divided doses
6 weeks
(2wk if uncomplicated right side) |
|
|
Term
| Pen allergic NVE Staph spp Tx |
|
Definition
Cefazolin 6g/24h in 3 divided doses
6 weeks |
|
|
Term
| MRSA and Coagulase Neg strains or severe/IgE mediated B-lactam allergy |
|
Definition
Vanco 15-20mg/kg q 8-12h (Trough15-20)
Dapto >/= 8mg q24h
6 weeks |
|
|
Term
| PVE methicillin susceptible Tx |
|
Definition
| Nafcillin/Oxcacillin (>/=6 wks) + Rifampin (>/=6wks) +Gentamicin(2weeks) |
|
|
Term
|
Definition
| Cefazolin 6g/24h in 3 divided doses >/=6wks + Rifampin (>/=6wks) +Gentamicin(2weeks) |
|
|
Term
| PVE Coag neg strains or severe/IgE mediated B-lactam allergy |
|
Definition
| Vanco 15-20mg/kg q 8-12h (Trough15-20) 6 weeks + Rifampin (>/=6wks) + Gentamicin(2weeks) |
|
|
Term
| MRSA bacteremia persisting for >7 days DO WHAT? |
|
Definition
| Switch to Daptomycin 10mg/kg/dose IV QD + Gentamicin or Rifampin |
|
|
Term
|
Definition
replace warfarin w/ IV heparin
(in case Surgery needed) |
|
|
Term
Mechanical valve and anticoag
DO WHAT? |
|
Definition
| Discontinue all anticoag in pt who had CNS embolic event. Discontinue for first 2 weeks of ABX Tx |
|
|
Term
| NO RENAL ADJUSTMENTS in..... |
|
Definition
|
|
Term
|
Definition
| not stable >24 hrs at room temp in pump |
|
|
Term
| Ceftriaxone dosing advantage |
|
Definition
once daily dosing
No renal adj! |
|
|
Term
|
Definition
Drug interxn
CYP3A4 strong inducer
HEPATOTOXICITY |
|
|
Term
|
Definition
Risk of myopathy
monitor CK weekly |
|
|
Term
|
Definition
|
|
