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Flashcards in IE Deck (21)
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1
Q

“typical MOs” for IE

A

Viridans streptococci

Streptococcus gallolyticus (formerly S. bovis)

HACEK group: Haemophilus spp, Aggregatibacter (formerly Actinobacillus actinomycete comitants), Cardiobacterium hominis, Eikenella spp, and Kingella kingae

Staphylococcus aureus

Community-acquired enterococci, in the absence of a primary focus;

Single positive blood culture for Coxiella burnetii or antiphase I IgG antibody titer >1:800*

2
Q

what is the special protein that some staph aureus have that makes them particularly good at causing IE?

A

it is the fibronectin binding protein

3
Q

what is the most common cause of early prosthetic valve (<2 months) IE?

A

40% are culture neg
20% ENT source
17% coag neg staph

4
Q

what is the most common cause of prosthetic valve IE (2 - 12 months after surgery)?

A

27% are coag neg staph
13% culture neg
7% is staph aureus

5
Q

what is the most common cause of late prosthetic valve IE? (>12 months)

A

staph aureus makes up 25%
20% enterococcus
12% culture neg
9% coag neg staph

mitral is more common than aortic

6
Q

what is the greatest risk factor for IE?

A

previous IE is the strongest

relapse is when it is the same MO within 6/12

reinfection is different bug > 6/12

7
Q

what is the most common cause of pacemaker associated ie?

A

coag neg staph is 54%

staph aureus is 23%

8
Q

if you think someone has brucella infective endocarditis, and blood cultures have failed to become positive, what is the next test?

A

you can do serology

or you could do a bone marrow

9
Q

what has a worse prognosis: early or late prosthetic valve endocarditis?

A

early has a 33-100% mortality

late 25-50% mortality

10
Q

what are the risk factors for death (from IE)?

A
age
staph aureus
CVA and embolic events
heart failure
health care associated IE
11
Q

what are the recommended empiric treatment for native valve IE?

A

acute presentation:
vanc plus gent

indolent:
amoxicillin plus gent

if pen allergy - vancomycin

12
Q

what is the empiric treatment for prosthetic valve IE?

A
if early (12 months): as per native valves
-- vanc plus gent or amoxi plus gent
13
Q

which of the strep are associated with invasion and abscesses?

A

Strep Anginosus (milleri)

14
Q

which of the strep is most likely to have the immunoloigically mediated signs?

A

strep viridans (sanguis and mutans)

15
Q

which population is Group B strep IE associated with?

A

preggos
immunosuppressed
alcoholics

these ones need surgery for cure

16
Q

what are the indications for urgent surgery in IE?

what about semi-urgent?

A

if heart failure due to IE, this is URGENT, esp if cardiogenic shock or refractory pulm oedema

semi-urgent:

uncontrolled infection - particularly fungal, s. aureus and s. lugdunenensis, group B strep
prevention of embolism
early PVE > late PVE

17
Q

what is the most common site, and most common bug for IE in IVDU?

A

tricuspid and s. aureus

usually only 1 in 3 have signs though

but might be symptomatic with fever, chills and pleuritic chest pain

18
Q

what is the most common cause of culture neg endocarditis?

A

apparently it is antibiotics being given prior to BCs

19
Q

what are the recommended pre-procedure antibiotic prophylaxis for dental procedures?

what about GIT/GUT procedures?

A

for dental it is:
amoxil 2g oral 1 hour prior
if pen allergy, clinda or cephalex orally 1 hour prior

for GIT/GUT where the mucosa might be crossed for biopsies, we need to cover enterococci:
IV amoxil 2g 30 minutes prior

if pen allergy:
vanco 1g given 30 min prior
or teicoplanin just before

20
Q

which of the congenital heart defects should have prophylaxis?

  1. VSD
  2. MVP
  3. tetralogy of Fallot
  4. asd
A

it’s only cyanotic heart disease

apparently even a VSD doesn’t get prophylaxis with a dental procedure these days

however, if the tooth is infected, then they should have antibiotics for the tooth infection

21
Q

what sorts of people get antibiotic prophylaxis in Australia?

A

any one with prosthetic material

anyone with cyanotic heart disease