Cardiac Device Related Infection

Cardiac Device Related Infection

University

10 Qs

quiz-placeholder

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Cardiac Device Related Infection

Cardiac Device Related Infection

Assessment

Quiz

Other

University

Medium

Created by

Bushra Johari

Used 5+ times

FREE Resource

10 questions

Show all answers

1.

MULTIPLE CHOICE QUESTION

30 sec • 1 pt

A 63-year-old male with a history of pacemaker insertion 2 weeks ago presents with a 2-day history of pain and swelling over the pacemaker area. On inspection, his temperature is 36.8C, heart rate 70/minute, respiratory rate 18/min, blood pressure 140/80, SpO2 98% on room air. There is an erythematous, tender swelling over the pacemaker site, with no pus exudate. What is the next immediate step?

Surgical debridement

Obtain two sets of blood culture

Transoesophageal echocardiogram

Transthoracic echocardiogram

2.

MULTIPLE CHOICE QUESTION

30 sec • 1 pt

A 50-year-old female presents with a 3-day history of pain over her implantable cardioverter defibrillator (ICD) site. On inspection, she is afebrile with stable vital signs. There is some erythema and swelling over the ICD site, with no obvious pus discharge. One set of blood cultures was negative. What is the most likely diagnosis?

Definite CIED infection

Deep pocket infection

Probable CIED infection

Superficial pocket infection

Answer explanation

Superficial pocket infection as patient is afebrile and blood cultures are negative

3.

MULTIPLE CHOICE QUESTION

30 sec • 1 pt

  1. A 65-year old male with a history of hypertension, diabetes mellitus and pacemaker inserted 6 weeks prior was initially admitted to the respiratory ward with a diagnosis of community acquired pneumonia. He developed new neurological deficits while in the ward and a CT brain revealed multiple intracerebral haemorrhage. Further history revealed a low grade fever and generalized malaise of 3 weeks duration. Upon further examination, there is erythema around the pacemaker site. What is the likely diagnosis?

Definite CIED infection with IE and embolic involvement

  1. Possible CIED infection with IE and embolic involvement

Definite CIED infection with IE and immunological phenomenon

Possible IE with embolic involvement

Answer explanation

Possible CIED infection with IE and embolic involvement. (1 major criteria [clinical evidence of CIED infection]  + 1 minor criteria [fever, possible vascular phenomenon])

4.

MULTIPLE CHOICE QUESTION

30 sec • 1 pt

  1. A 75-year-old female with ESRD and a history of ICD insertion presents with a 6-day history of fevers and chills. Her preliminary blood cultures results show gram positive cocci. What is the most likely causative organism?

Coagulase negative Staphylococcus

Corynebacterium striatum

  1. Enterococcus spp.

Streptococcus spp.

Answer explanation

Coagulase negative Staphylococcus is the commonest, followed by S. aureus.

5.

MULTIPLE CHOICE QUESTION

30 sec • 1 pt

A 70-year-old female with a history of rheumatic mitral stenosis and recent ICD insertion presents with 4 days of fevers and night sweats, malaise, and multiple small erythematous lesions on the soles of the feet. Echocardiogram reveals lead and valve vegetations. Which of the following is the most likely organism to be isolated from blood cultures?

Escherichia coli

  1. Pseudomonas aeruginosa

Staphylococcus aureus

  1. Streptococcus spp.

Answer explanation

Staphylococcus aureus (For CIED infections: CoNS commonest, followed by S. aureus, followed by GNB)

6.

MULTIPLE CHOICE QUESTION

30 sec • 1 pt

A 70-year-old male with a history of mitral valve replacement and an ICD is admitted with fever for 2 weeks. There is erythema around the ICD site and pus was drained. Blood cultures grew methicillin resistant CoNS and echocardiogram showed vegetation on the leads and the mitral valves. 
Which of the following is the MOST appropriate management regarding this patient’s ICD and leads?

Consider removal of device if persistent bacteraemia

  1. Removal of device and antibiotic therapy for 2 weeks after extraction

Removal of device and antibiotic therapy for 4 weeks after extraction

Removal of device and antibiotic therapy for 4 - 6 weeks after extraction

Answer explanation

Removal of device and antibiotic therapy for 4 - 6 weeks (CIED infection with prosthetic valve endocarditis)

7.

MULTIPLE CHOICE QUESTION

30 sec • 1 pt

  1. A 60-year old male presents with redness and slight tenderness over his pacemaker site which was inserted 1 week ago. He is otherwise well with normal vital signs. On examination, there is slight erythema over the pacemaker site, with no evidence of pus. His blood cultures were negative and transoesophageal echo was normal. What is the best management for this patient?

  1. Remove entire CIED

Retain CIED

Retain CIED and intravenous antibiotics for 7 - 10 days

  1. Retain CIED and oral antibiotics for 7 - 10 days

Answer explanation

Retain CIED and oral antibiotics for 7 - 10 days (Superficial incisional infection)

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