iPTX 3 exam 3 - infective endocarditis, iPTX 3 exam 3 - Bacterial Meningitis, iPTX 3 exam 3 - Med Chem: Antifungal Drugs, iPTX 3 exam 3 - Superficial Fungal Infections, iPTX 3 exam 3 - Invasive Fungal Infections, iPTX3 EX4 L4 (MEDCHEM NON-HIV ANTI-VI…

T or F:

Infective Endocarditis (Inf. Endo) is the fourth most common life-threatening infection following sepsis, pneumonia, and intra-abdominal abscess

True

T or F:

Mortality rates vary with infecting organisms

True

What is the meidan length of stay for Inf. Endo?

10 days

What is the pathophysiology of Inf. Endo?

Bacteria adheres to an surface such as a compromised cardiac valve, platelest and fibrin deposit on the endothelial surface, pathogens in the blood adhere to the deposit, Biofilms and vegetation occur, inflammatory response occurs

What are the risk factors for Inf. Endo?

Proesthetic heart Valve, Cardiac Implantable Electronic Device (CIED), Injection Drug Use, Structural Heart Disease, Persistent bacteremia, Repeated exposure to healthcare environments, poor dental hygiene.

What are 4 examples of Structural heart disease?

Congenital Defect, Rheumatic Heart Disease, Mitral Valve Prolapse, Degenerative valvular lesions

What is the most common cause of Inf. Endo?

S. aureus

Which of the CoNs microbes are more virulent?

S. lugdunensis

T or F:

Most CoNs are Methicillin-Susceptible

False

what are the 2 examples of CoNs microbes that commonly cause Inf. Endo?

S. epidermidis, S. lugdenensis

Which microbe group are most commonly associated with dental plaques?

Viridians Group Streptococci (VGS)

What are the examples of VGS?

S. sanguis, S. oralis, S. salivarus, S. mutans, Gemella morbillorum

What microbe group forms abscesses and metasasis to extracardiac sites?

S. anginosus group

What microbe group commonly causes GI or genitourinary tract infections?

Group D streptococci

What is an example of a Group D streptococi?

S. gallolyticus

What is procedure is recommended with a concern for S. gallolyticus infection?

Colonoscopy

What microbe is responsible for 97% of enterococcal IE (Inf. Endo) cases?

E. faecalis

T or F:

E. faecium causes more enteroccoal Inf. Endo cases than E. faecalis

False

What kind of ABx therapy is needed to terat enterococci Inf. Endo?

Synergistic combo therapy (Bactericidal)

What microbes have a high risk of infection associated with IV catheters, cardiac devices and prosthetic valves?

Fungi

What heart valve(s) is most involved with Left-sided IE?

Mitral, aortic

What occurs as a result of Left-sided IE?

Peripheral emboli, neurological stroke features

What heart valve(s) is most involved with Right-sided IE?

Tricuspid, pulmonary valves

What occurs as a result of Right-sided IE?

Septic pulmonary emboli

T or F:

Injection drug use is more common with Left-Sided IE

False

T or F:

Left-sided IE has lower curable rates and higher mortality rates than Right-sided IE

True

What is the main difference between subacute IE and acute IE regarding its symptom onset?

Subacute is gradual and over weeks, Acute is more sudden and over days

What are differentiating symptoms of IE compared to a general infection?

SOB, worsening or new onset of HF

What S/sx are associated with general infection?

Fever (> 38 C), leukocytosis (> 12,000), Hemodynamic instability ( < 90 mmHg SBP, < 65 mmHg MAP; > 90 bpm, > 22 breaths/min)

What are the 3 types of vascular & immunologic phenomena involved with IE?

Janeway lesions, Osler nodes, Roth spots

What diagnostic tool is used as the initial screening of IE?

Transthoracic echocardiogram (TTE)

What diagnostic tool is more preferred for patients with prosthetic valves or CIEDs?

Transesophageal echocardiogram (TEE)

What are Janeway lesions more associated with?

Septic micro emboli; on the soles and palms

What are Osler nodes associated with?

Vasculitis; on the fingers and toe tips

What are Roth spots associated with?

Intra-retinal hemorrhage

What 3 Major diagnostic categories are used in Duke-ISCVID criteria?

Microbiologic, imaging, surgical

What are the different types of Minor diagnostic categories used in Duke-ISCVID criteria?

Predisposition to IE, Fever, vascular phenomena, immunologic phenomena, microbiologic evidence, physical exam findings

What is the diagnositic definition of IE?

Pathologic criteria OR clinical criteria

What are the 3 ways of clinical criteria is IE diagnosed?

2 major criteria OR 1 Major criteria + 3 Minor criteria OR 5 minor criteria

what are the 2 clinical crtieria is IE possible in a patient?

1 major criterion + 1 minor criterion. OR 3 minor criteria

What are the 4 ways diagnostics of IE is rejected?

Another diagnosis explaining S/sx, Lack of recurrence with ABx < 4 days, No evidence at surgery/autopsy with ABx < 4 days, does not meet possible criteria

What are the benefits of having a multidisciplinary team for the treatment of IE?

Decreased short-term mortality rates, decreased time to surgery, increased surgery rates

What does surgery help with in treating IE?

Prevents embolism, repairs damaged cardiac valves, restores cardiac function

How many hours is considered early surgery intervention for IE?

48 - 72 hours

T or F:

Early surgery is favored (48 - 72 hours) for IE, unless there was a hemorrhagic or major ischemic stroke

True

What is the goal ABx therapy in IE?

Eradicate the causative pathogen(s), which may also require surgery

What is prolonged treatment defined as for IE ABx treatment?

Cumulative pathogen-directed ABx therapy provided AFTER bacteremia clearance

What ABx are the initial treatments for Native MSSA IE?

Naficillin, Oxacillin, Cefazolin

what ABx are used as continuation regimens for Native MSSA IE?

Dalbavancin, Ortiavancin, Dicloxacillin + Rifampin, Linezolid + Rifampin

what ABx are used as initial treatments for Native MRSA IE?

Vancomycin, Daptomycin (dosed 8 - 12 mg/kg), Ceftaroline, Linezolid

What ABx are used as continuation regimens for Native MRSA IE?

Dalbavancin, Linezolid + Rifampin

What is the treatment duration for Staphylococci Native Valve IE treatment?

4 weeks

T or F:

Pathogen-directed treatment duration begins before bacteriemia clearance

False

What ABx are used as initial treatments for MSSA Prosthetic Valve IE?

Naficillin OR Oxacillin OR Cefazolin + Rifampin

What ABx are used as initial treatments for MRSA Prosthetic Valve IE?

Vancomycin OR Daptomycin (dosed 8 - 12 mg/kg) OR Ceftaroline OR Linezolid + Rifampin

What is the treatment duration for MRSA Prosthetic Valve IE?

6 weeks

What ABx are used as initial treatment for Streptococci IE?

Penicillin G, Ceftriaxone

what are the ABx alternatives for initial treatment for Streptococci IE if a patient is allergic to penicillin?

Vancomycin, Linezolid

What injectable ABx are used for continuation regimen for Streptococci IE?

Dalbavancin, Oritavancin

What PO ABx are used for continuation regimen for Streptococci IE?

Amoxicillin + Linezolid, Linezolid + Rifampin, Linezolid + Moxifloxacin

What ABx is used for initial treatment for Penicillin-intermediate IE?

Ceftriaxone

What injectable ABx is used for continuation regimen of Penicillin-intermediate IE?

Dalbavancin, Oritavancin

What PO ABx are used for continuation regimen of Penicillin-intermediate IE?

Linezolid + Rifampin, Moxifloxacin + Rifampin, Moxifloxacin + Clindamycin

What ABx are used for initial treatment of Penicillin-Resistant IE?

Ceftriaxone + Gentamicin (for the first 2 weeks), Vancomycin

What injectable ABx is used for continuation regimen of Penicillin-resistant IE?

Dalbavancin, Ortiavancin

What PO ABx is used for continuation regimen of Penicillin-resistant IE?

Linezolid + Rifampin, Moxifloxacin + Rifampin, Moxifloxacin + Clindamycin

What is the treatment duration of Streptococci IE treatment for a native valve?

4 weeks

What is the treatment duration of Streptococci IE treatment for a prosthetic valve?

6 weeks

What is the dosing of Daptomycin in the initial treatments for VRE?

10 - 12 mg/kg

What is the treatment duration of Enterococci IE?

6 weeks

T or F:

Clinical evidence is sufficient enough to support the use of rifampin in IE treatment

False

In Dual B-Lactam therapy, ampicillin binds to PBP __ & ___

4, 5

In Dual B-Lactam therapy, Ceftriaxone binds to PBP ___ & ___

2, 3

What is the main advantage(s) of using Dual B-Lactam therapy?

Less nephrotoxicity, no therapeutic drug monitroing

What are the ineligible criteria for Step-Down to PO therapy treatment?

BMI > 40, Reduced PO absorption, concomitant infection needing IV therapy, reduced medication adherence

What are the ineligible criteria for Step-Down to Lipoglycopeptide treatment?

Cost, Availability, Drug interactions, Drug allergy

What DDI does Oritavancin have?

Coagulation assays (increasing PT & aPTT times), inhibits warfarin metabolism

T or F:

UFH is CI for 120 after dalbavancin administration

False

T or F:

ABx prophylaxis is suggested in all dental procedures that involve manipulation of gingival tissue or periapical region of teeth OR perfortation of the oral mucosa and 4 criteria

True

What are the 4 criteria for patients that need ABx prophylaxis for dental procedures?

Prosthetic cardiac valve, previous/relaspe/recurrent IE, congenital heart disease, cardiac transplant recipients who develop cardiac valvulopathy

What is the preferred ABx that is used for a patient that is able to do PO medication for dental ABX prophylaxis

Amoxicillin

what are the preferred ABx that is used for a patient that cannot do PO medication for dental ABX prophylaxis?

Ampicillin, Cefazolin, Ceftriaxone

What are the preferred ABx that is used for a patient with Penicillin/Amoxicillin allergy and that can take PO medication for dental ABX prophylaxis?

Keflex, Cefuroxime, Azithromycin, doxycycline

What are the preferred ABx that is used for a patient with penicillin/amoxicillin allergy and CANNOT take PO medication for dental ABX prophylaxis?

Cefazolin, Ceftriaxone

T or F:

Administer a single ABx dose 30 - 60 minutes AFTER the procedure

False

what are the biggest risk factors with Meningitis?

Extremes in age (< 1 yr and > 65 yr), unvaccinated individuals, anatomical/functional asplenia

What is bacterial meningitis?

inflammation/infection affecting the meninges with positive bacterial cultures

What is a common type of aseptic meningitis?

Drug-induced Aseptic Meningitis (DIAM)

What are the most common causes of DIAM?

NSAIDS, IVIG, aminopenicillins, sulfonamide ABx

what is the most common microbe(s) that cause community-acquired meningitis in ages 2 - 50?

S. pneumoniae, N. meningitis

What is the predisposing factor of healthcare-associated bacterial meningitis?

Common Bacterial Pathogens

what are the risk factors for Listeria monocytogenes?

Extremes in ages, alcoholism, malignancy, use of chornic corticosteroids, immunocompromised, diabetes, cirrhosis, pregnancy, CKD

What is the pathogenesis of bacterial meningitis?

Microbes colonize nasopharynx --> invasion of intravascular space --> avoids immune system detection in bloodstream --> infection of choroid plexus epithelial cells --> bacteria multiples in CSF --> massive production of CSF cytokines and chemokines

What is the meninges composition for Outermost to Innermost?

Dura mater --> Arachnoid mater --> subarachnoid space (CSF) --> Pia mater

What are the classid triad of the S/sx of meningitis?

Fever, Nuchal rigidity (neck stiffness), AMS

What are the main S/Sx for encephalitis?

Profound AMS (confusion, behavioral abnormalities), focal/generalized seizures, focal neurological disturbances (ataxia, aphasia)

What are the 2 types of physical examinations for bacterial meningitis?

Brudzinksi's Sign, Kernig's Sign

What is Brudzinski's sign?

Severe neck stiffness causes the patient's hips/knees to flex when the neck is flexed

What is Kernig's sign?

Severe stiffness of the hamstrings that causes an inability to straighten the leg when the hip is flexed to a 90 degree angle

T or F:

Neonates and Infants present with more specific S/sx and either positive Brudzinski/Kernig's sign

False