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ENDOCARDITIS (6, clinical presentations (7, Treatment (Non pharmacologic…
ENDOCARDITIS
6, clinical presentations
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1, Continuos bacteremia
2, Ecocardiography ECG
3, Chest Radiograph
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Lab abnormalities
1, anemia
2, WBC
3, ESR
4, C - reactive protein
5, urinary analysis
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Prognosis
1, Mortality
2, Improving outcome
7, Treatment
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Inoculum Effect
The effects of high bacterial densities on antimicrobial activity
I. Beta -lactams
Ii. Glycopeptides
Iii. Lipopeptides such as daptomycin
Fluoroquinolones and aminoglycoside diferrent mechanisms of bactericidal activity
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8, Prosthetic Valve (PV)
Or Valvular Prosthetic Matetials (VPM)
1.
1, Highly Penicillin Susceptible (MIC less than equal 0.12 mcg/mL Viridans group Streptococi and Streptococus Bovis
I, Aqueous crystaline penicillin G Na w or W/o gentamycin 6 weeks
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2,
Relatively resistant or fully Resistant (MIC more than 0.12 mcg/mL ) Viridans Group Streptococi and S.Bovis
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3.
- Oxacillin susceptible Staphylococci
1, Nafcillin or oxacillin 6 weeks
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- Vancomycins 6 weeks
Daptomycin 6 weeks
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7, Native Valve Infective Endocarditis (NVE)
- (MIC more than 0.12 mcg/mL to less than equal 0.5 ) Viridans Group Streptococi and S.Bovis resistance to Penicillin .
1, Aqueous crystalline penicillin G Na + gentamicin 4 weeks
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2, Ceftriaxone + gentamicin 2weeks
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- Highly Penicillin Susceptible (MIC less than equal 0.12 mcg/mL Viridans group Streptococi and Streptococus Bovis
1, Aqueous crystalline penicillin G Na + gentamicin 4 weeks
2, Ceftriaxone 4weeks
Aqueous crystalline penicillin G Na + gentamicin 2 weeks
2, Ceftriaxone + gentamicin 2weeks
3, Vancomycins 4 weeks
3,
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1, Nafcillin or oxacillin 6 weeks
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- Oxacillin - resistant Staphylococci
Vancomycins 6 weeks
Plus
Rimampin more than 6 weeks
Plus
Gentamycin
2, classifications
1, etiologic organism
2, anatomic site of infections
3.Pathogenic risk factors
4, surgical insertion of prosthetic heart valve
4, Etiology
1, Streptococci
2, Staphylococci (S.aureus ,coagulase -staph)
- Enterococci
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10, other microorganism
1, Staphylococci
2, Enterococci
3, HACEK microorganism
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12, prophylaxis of Infective Endocarditis
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