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Endocarditis Common Microorganisms
- Staphylococci
- • Staphylococcus aureus
- → Most common cause of infective endocarditis
- → Common in IVDUs
- • Coagulase‐negative Staphylococcus
- → Most common cause of early prosthetic valve endocarditis
- Streptococci
- • Common cause of community‐acquired, native valve endocarditis in non‐IVDUs with underlying cardiac abnormalities
- • Viridans streptococci (S. sanguis, S. mutans, S. mitis, S. salivarius, etc.)
- → May follow dental procedures
- • Streptococcus bovis
- → Often associated with colonic lesion/malignancy
- Enterococci
- • May follow GI or GU procedures
- • Enterococcus faecalis
- • Enterococcus faecium
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Endocarditis HAECK Microorganisms
- • Haemophilus species (H. parainfluenzae, H. aphrophilus, H. paraphrophilus)
- • Aggregatibacter (formerly Actinobacillus) actinomycetemcomitans
- • Eikenella corrodens
- • Cardiobacterium hominis
- • Kingella kingae
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Streptoccoccal Endocarditis (PCN susceptible; MIC ≤0.12): Native Valve (4 wk preferred)
- • PCN G 12‐18 mu/day IV divided q4h
- • Ceftriaxone 2 g IV q24h
- • Preferred in elderly and pts w/renal impairment
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Streptoccoccal Endocarditis (PCN susceptible; MIC ≤0.12): Native Valve (2 wk preferred)
- • Penicillin G + gentamicin
- • Ceftriaxone + gentamicin
- • Pts w/out cardiac or extracardiac abscesses, CrCl ≥20
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Streptoccoccal Endocarditis (PCN susceptible; MIC ≤0.12): Native Valve (alternative)
Vancomycin x4 wks (trough 15-20 mcg/mL)
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Streptoccoccal Endocarditis (PCN susceptible; MIC ≤0.12): Prosthetic Valve (preferred)
- • PCN G 24 million units/day IV divided q4h x6 wks ± gentamicin x2 wks
- • Ceftriaxone x6 wks ± gentamicin x2 wks
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Streptoccoccal Endocarditis (PCN susceptible; MIC ≤0.12): Prosthetic Valve (alternative)
Vancomycin x6 wks
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Streptoccoccal Endocarditis (PCN resistant; MIC >0.12, ≤0.5): Native Valve (preferred)
- • PCN G 24 mu/day IV divided q4h x4 wks + gentamicin x2 wks
- • Ceftriaxone 2 g IV Q24H x4 wks + gentamicin x2 wks
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Streptoccoccal Endocarditis (PCN resistant; MIC >0.12, ≤0.5): Native Valve (alternative)
Vancomycin x4 wks
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Streptoccoccal Endocarditis (PCN resistant; MIC >0.12, ≤0.5): Prosthetic Valve (preferred)
- • PCN G 24 mu/day + gentamicin x6 wks
- • Ceftriaxone + gentamicin x6 wks
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Streptoccoccal Endocarditis (PCN resistant; MIC >0.12, ≤0.5): Prosthetic Valve (alternative)
Vancomycin x6 wks
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Streptoccoccal Endocarditis (Fully PCN resistant; MIC >0.5)
See Enterococcal Endocarditis Tx
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Enterococcal Endocarditis (Preferred)
- • Ampicillin 2 grams IV Q4H + gentamicin
- • PCN G 18‐30 million units/day IV either continuously or divided Q4H + gentamicin
- • Native valve
- → S/x ≤ 3 months- 4 wks
- → S/x >3 months- 6 wks
- • Prosthetic valve- 6 wks
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Enterococcal Endocarditis (Alternative)
- • Vancomycin + gentamicin x6 wks
- • If resistant to gentamicin: substitute streptomycin
- • If β‐lactamase producing strain: use ampicillin‐sulbactam or vancomycin + gentamicin
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Staphylococcal Endocarditis (β‐lactam Susceptible): Native valve (Preferred)
- • Usually MSSA
- • Nafcillin/oxacillin 12 grams/day IV divided q4h x6 wks ± gentamicin x3‐5 days
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Staphylococcal Endocarditis (β‐lactam Susceptible): Native valve (Alternative)
- • Usually MSSA
- • Cefazolin 2 grams IV q8h x6 wks ± gentamicin x3‐5 days
- • Vancomycin x6 wks ± gentamicin x3‐5 days
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Staphylococcal Endocarditis (β‐lactam Susceptible): Prosthetic valve (Preferred)
- • Likely MSSA
- • Nafcillin/oxacillin x≥6 wks + rifampin 300 mg IV/PO TID x≥6 wks + gentamicin x2 wks
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Staphylococcal Endocarditis (β‐lactam Susceptible): Prosthetic valve (Alternative)
- • Likely MSSA
- • Cefazolin x≥ 6 wks + rifampin x≥6 weeks + gentamicin x2 wks
- • Vancomycin x≥ 6 wks + rifampin x≥6 weeks + gentamicin x2 wks
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Staphylococcal Endocarditis (β‐lactam Resistant): Native valve
- • Usually MRSA, also MRSE
- • Vancomycin x6 wks ± gentamicin x3‐5 days
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Staphylococcal Endocarditis (β‐lactam Resistant): Prosthetic Valve
- • Often MRSE, also MRSA
- • Vancomycin x≥6 wks + rifampin x≥6 wks + gentamicin x2 wks
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IVDU with Staphylococcal Endocarditis
- • Nafcillin/oxacillin + gentamicin x 2 wks
- • Only for uncomplicated right‐sided endocarditis due to MSSA
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HAECK Endocarditis
- • Ceftriaxone 2g q24h
- • Ampicillin/sulbactam 12g/q24h divided in 4 doses
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