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Infective endocarditis

Prevalence
Clinical features
Investigations
Therapy
Prevention
Prognosis
Investigations

Duke criteria  b

Definite

Any of

  • pathological criteria
    • micro-organism: demonstrated by culture or histology in a vegetation, or in a vegetation that has embolised or in an intracardiac abscess, or
    • pathological lesions: vegetation or intracardiac abscess present, confirmed by histology showing active endocarditis
  • clinical criteria: any of (see below for definitions)
    • 2 major criteria
    • 1 major and 3 minor criteria
    • 5 minor criteria
Possible

  • findings consistent with infective endocarditis that fall short of 'definite' but not 'rejected'
Rejected 

Any of

  • firm alternative diagnosis explaining evidence of infective endocarditis
  • resolution of infective endocarditis syndrome with antibiotic treatment for < 4 days
  • no pathological evidence of infective endocarditis at surgery or autopsy with antibiotic therapy for < 4 days
Major criteria  
positive blood culture for infective endocarditis
  • typical microorganisms for infective endocarditis from 2 separate blood cultures
    • Viridans streptococci, Streptococcus bovis, HACEK* group
    • commonly-acquired Staphylococcus aureus or enterococci in absence of primary focus
  • persistently positive blood culture defined as a micro-organism consistent with infective endocarditis from
    • blood cultures drawn more than 12 hours apart
    • all three, or a majority of 4 or more blood cultures with first and last drawn at least 1 hours apart
evidence of endocardial involvement: positive echocardiogram for infective endocarditis
  • oscillating intracardiac mass on valve or supporting structure in the path of regurgitant stream or on iatrogenic devices in the absence of an alternative anatomical explanation
  • abscess
  • new partial dehiscence of prosthetic valve or new valvular regurgitation (worsening or changing of pre-existing murmur not sufficient)
 
Minor criteria
predisposing heart condition or iv drug use
fever ≥ 38°C
vascular phenomena: arterial embolism, septic pulmonary infarcts, mycotic aneurysm, intracranial haemorrhage, Janeway lesions
immunological phenomena: glomerulonephritis, Osler's nodes, Roth spots
echocardiogram consistent with infective endocarditis but not meeting major criteria as noted previously, or serological evidence of active infection with organism consistent with infective endocarditis
 

*HACEK = Haemophilus, Actinobacillus, Cardiobacterium, Eikinella and Kingella spp

 

Expiry date: July 2003
Levels of Evidence used in grading these guides

Authors   CM   Ball , C   Hennigan , S   Dhingra
Reviewer   E   Abrutyn
CAT Writers   CM   Ball , C   Hennigan , S   Dhingra