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LECTURE
1 Dental treatment.
2 Endoscopic procedures
3 Urinary tract infections.
4 Bowel infections.
Bacteremia + SIRS
Bacteremia
Sepsis
Sepsis+CVS
dysfunction and/or
ARDS
Severe sepsis
sepsis+hypotension
despite adequate fluid
resuscitation
Septic Shock
Transient (resolve
spontaneously)
MODS
Severity
Bacteremia+ Endotoxins
Pathogenesis
Monocyte/Macrophage
septic shock
MODS
Treatment
Bacteremia
Penicillin or Amoxicillin
Bacteremia + SIRS
IV Penicillin + Gentamycin
Or
IV Ceftriaxone
Sepsis
Severe sepsis
IV fluid
Noradrenaline
Oxygen supply
Septic Shock
MODS
Severity
Bacteremia
Bacteremia: GBS is the most common cause in
Sources of bacteremia:
Follows the distribution of normal flora.
SIRS
NOT only caused by infection.
Criteria: 2 or more of the following:
Temp. (High/Low) ; Breathing (fast) ; WBC
MODS
Primary MODS:
Fungemia
It is most commonly seen in:
1. Immunocompromised patients
HIV positive individual : Penicillium marneffei fungemia is
one of the AIDS-defining illness.
Viremia
Primary: refers to the initial spread of virus in the
LECTURE
INFECTIVE ENDOCARDITIS
Early Prosthetic
valves (60 Days)
Late Prosthetic
valves
Direct intraoperative
contamination
Endothelialization of
the sutures
(attachment sites for
bacteria)
Staphylococcus
epidermidis
High-pressure
gradients and
turbulent flow
IVDU
Drug particles
bombardment
Staphylococcus aureus
Bacterial vegetation
INFECTIVE ENDOCARDITIS
The mitral valve is most commonly affected.
IVDU= Right sided IE (Tricuspid valve)
Staphylococcus aureus can infect normal/abnormal
heart valves.
Streptococci and enterococci infect previously abnormal
valves.
Prophylaxis for oral procedures is directed mainly against
streptococcus sp.
Negative cultures:
Prior antibiotics.
2. HACEK group (Haemophilus, Actinobacillus,
Cardiobacterium, Eikenella, and Kingella),
3. Bartonella species.
4. Coxiella burnetii.
1.
Clinical features
Staphylococcus is usually associated with acute
IE.
Streptococcus is usually associated with
subacute IE.
Fever + Murmur = Most common
Splinter hemorrhage
There is a history of invasive procedure or
Cutaneous Findings
Osler nodes :
or soles.
Duke criteria
Major criteria
1. Positive blood culture for IE
At least 2 positive cultures drawn >12 h apart.
OR
3 separate blood cultures (with first and last
drawn at least 1 h apart).
Coxiella burnetii: 1 positive culture is enough.
2. Echocardiography: Intracardiac vegetation.
Minor criteria
1. Underlying risk factor.
2. Fever: temperature >38C
3. Vascular phenomena: Janeway lesions
4. Immunologic phenomena: Osler nodes.
5. Microbiologic evidence: Not a common
microorganism for IE.
Treatment
4 weeks course of high dose antibiotics
Prosthetic valve IE:
Vancomycin + Gentamicin + Rifampicin
The rest of risk factors:
Vancomycin + Gentamicin
High risk:
Prosthetic valves
Previous IE
Cyanotic heart disease
Anything else
Amoxicillin or Ampicillin
Ampicillin + Gentamicin
Prophylaxis
THANK YOU
GOOD LUCK