Bacterial endocarditis

HOST FACTORS A critical determinant of antibiotic efficacy is the status of the host humoral and cellular defense mechanisms. In the immunocompetent host, merely halting the multiplication of the microorganism with a bacteriostatic agent frequently is sufficient to cure the infection. If host defenses are impaired, bacteriostatic activity may be inadequate and a bactericidal agent is required for cure. Examples where this applies include bacterial endocarditis, bacterial meningitis, and disseminated bacterial infections in nentropenic patients. Patients with HIV-1 infection and acquired immunodeficiency syndrome have impaired cellular immune responses. Therapy for opportunistic infection therefore often is snppressive bnt not cnrative disseminated infections with Salmonella or atypical mycobacteria typically require prolonged antibiotic therapy to prevent relapse. 

Antimicrobials also can be classified as possessing bactericidal or bacteriostatic activity in vitro. Bactericidal antibiotics generally kill at least 99.9% (3 log reduction) of a bacterial population, whereas bacteriostatic antibiotics possess antimicrobial activity but reduce bacterial load by less than 3 logs. Clinically, bactericidal antibiotics may be necessary to achieve success in infections such as endocarditis or meningitis. A full discussion of the application of antimicrobial pharmacodynamics is beyond the scope of this chapter, but excellent sources of information are available.15... 

O For infective endocarditis to develop, the occurrence of several factors is required. These factors involve alterations to the endocardial surface that allow for bacterial adherence and eventual infection. 

Dajani AS, Taubert KA, Wilson W, et al. Prevention of bacterial endocarditis Recommendations by the American Heart Association. JAMA 1997 277 1794-1801. 

Flame hemorrhage Bleeding into the sclera in a pattern similar to a fork or flame. May be associated with bacterial endocarditis. 

Infective endocarditis Historically referred to as bacterial endocarditis, this is an infection, either acute or subacute, that primarily affects the heart valves, but may extend into other surrounding areas of the heart. 

Osier s node Raised, painful, red lesions found on the finger pulps and soles of the feet indicative of subacute bacterial endocarditis. Osier s nodes are caused by immune complex deposition. 

Although used as a simulant, it can cause acute bacterial meningitis, pneumonia, intraabdominal infections, enteric infections, urinary tract infections, septic arthritis, endophthalmitis, suppurative thyroiditis, sinusitis, osteomyelitis, endocarditis, and skin and soft tissue infections. There are also strains of E. coli (C17-A015) that produce lethal cytotoxins (C16-A052). ... 

The manifestations of inflammation with deep-seated infections such as meningitis, pneumonia, endocarditis, and urinary tract infection must be ascertained by examining tissues or fluids. For example, the presence of polymorphonuclear leukocytes (neutrophils) in spinal fluid, lung secretions (sputum), and urine is highly suggestive of bacterial infection. 

Endocarditis is often referred to as either acute or subacute depending on the clinical presentation. Acute bacterial endocarditis is a fulminating infection associated with high fevers, systemic toxicity, and death within days to weeks if untreated. Subacute infectious endocarditis is a more indolent infection, usually occurring in a setting of prior valvular heart disease. 

Scabies is a skin infection caused by mites. Septicaemia occurs when bacterial microorganisms or their toxins enter the bloodstream. Endocarditis refers to bacterial infections of the endocardium. Peritonitis occurs when bacterial microorganisms infect the peritoneum. Shighellosis refers to infections caused by the Shighella bacteria. 

It is used for bacterial infections caused by microorganisms that are sensitive to the drug. These may be abdominal and gynecological infections, sepsis, meningitis, endocarditis, infections of the urinary and respiratory tracts, bones, joints, skin, and soft tissnes. It is widely nsed for pneumonia as well as bacterial meningitis in children, and for post-operational infections complications. Synonyms of this drug are ceftin, zinacef, curoxim, kefox, and many others. 

It is used for severe bacterial infections peritonitis, sepsis, meningitis, osteomyelitis, endocarditis, pneumonia, pleural empyema, pulmonary abscess, purulent skin and soft tissue infections, and infections of the urinary tract that are caused by microorganisms sensitive to the drug. Synonyms of this drag are amikin, bikhn, novamin, and others. 

Cardiovascular- Subacute bacterial endocarditis arterial sclerosis dissecting... 

Severe renal impairment (Ccr less than 30 mL/min) fondaparinux as prophylactic therapy in patients with body weight less than 50 kg undergoing hip fracture, hip replacement, or knee replacement surgery active major bleeding bacterial endocarditis thrombocytopenia associated with a positive in vitro test for antiplatelet antibody in the presence of fondaparinux known hypersensitivity to fondaparinux. 

Bacterial endocarditis - Only in 600,000 to 1 million units/day IM extremely sensitive infections (Group A streptococci)... 

IM Treatment of serious infections of mild to moderate severity where IM therapy is appropriate. Not intended for severe or life-threatening infections, including bacterial sepsis or endocarditis, or in major physiological impairments (eg, shock). 

Erythromycin is no longer recommended by the American Heart Association for the prevention of bacterial endocarditis. However, practitioners may continue to use erythromycin if they have had success with its use. 

Prop/ y/acf/c-Although no controlled clinical efficacy studies have been conducted, IV vancomycin has been suggested for prophylaxis against bacterial endocarditis in penicillin-allergic patients who have congenital... 

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