Infective Endocarditis

1) DEFINITE INFECTIVE ENDOCARDITIS

• A) Pathologic Criteria
• • Microorganisms demonstrated by results of cultures or histologic examination of a vegetation, a vegetation that has embolized, or an intracardiac abscess specimen; or • Pathologic lesions; vegetation, or intracardiac abscess confirmed by results of histologic examination showing active endocarditis
• B) Clinical Criteria
• • 2 major criteria, or • 1 major criterion and 3 minor criteria, or • 5 minor criteria

2) POSSIBLE INFECTIVE ENDOCARDITIS

• • 1 major criterion and 1 minor criterion, or • 3 minor criteria

3) REJECTED DIAGNOSIS OF INFECTIVE ENDOCARDITIS

• • Firm alternate diagnosis explaining evidence of suspected IE, or • Resolution of IE syndrome with antibiotic therapy for ≤4 days, or • No evidence of IE at surgery or autopsy, on antibiotic therapy for ≤4 days, or • Does not meet criteria for possible IE

4) DEFINITION OF TERMS USED IN MODIFIED DUKE CRITERIA

• A) Major Criteria
• 1) Blood culture findings positive for IE Typical microorganisms consistent with IE from 2 separate blood cultures:
• • Viridans streptococci, Streptococcus gallolyticus (formerly known as S. bovis), Staphylococcus aureus, HACEK group, or • Community-acquired enterococci, in the absence of a primary focus, or
• 2) Microorganisms consistent with IE from persistently positive blood culture findings, defined as:
• • ≥2 positive culture findings of blood samples drawn >12 hr apart, or • 3 or most of ≥4 separate culture findings of blood (with first and last sample drawn ≥1 hr apart) • Single positive blood culture for Coxiella burnetii or anti–phase I lgG titer ≥1:800
• 3) Evidence of endocardial involvement
• 4) Echocardiographic findings positive for IE (TEE recommended in patients with prosthetic valves, rated at least possible IE by clinical criteria or complicated IE [paravalvular abscess]; TTE as 1st test in other patients), defined as follows:
• • Oscillating intracardiac mass on valve or supporting structures, in the path of regurgitant jets, or on implanted material in the absence of an alternative anatomic explanation, or • Abscess, or • New partial dehiscence of prosthetic valve New valvular regurgitation; worsening or changing of preexisting murmur not sufficient
• B) Minor Criteria
• 1) Predisposition, predisposing heart condition, or intravenous drug use
• 2) Fever—temperature >38°C
• 3) Vascular phenomena, major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, and Janeway lesions
• 4) Immunologic phenomena: glomerulonephritis, Osler nodes, Roth spots, and rheumatoid factor
• 5) Microbiologic evidence: positive blood culture finding but does not meet a major criterion as noted above (excludes single positive culture findings for coagulase-negative staphylococci and organisms that do not cause endocarditis) or serologic evidence of active infection with organism consistent with IE