Chapter 83 infective endocarditis and valvular disease. These were originally proposed in 1994 to help establish the diagnosis of endocarditis. The recently proposed duke criteria were confirmed to be more sensitive than the former. Healthcare related infections now account for 2530% of newly reported cases of endocarditis. The duke criteria for the diagnosis of endocarditis provide a systematic approach for diagnosing both native valve endocarditis nve and pve. Infective endocarditis adult inpatient clinical practice. Recognize the signs, symptoms, and duke criteria that aid in the diagnosis of ie. Interestingly, in 20% of the cases, there was no cardiology consultation prior to the tee, and in 20% of the cases, there was no documented bacteremia table 2. Aha scientific statement on infective endocarditis 2015. The agents are usually bacterial, but other organisms can also be responsible. Main complications of leftsided valve ie and their management. Pathologic criteria are histological or culture confirmation ofpathologic criteria are histological or culture confirmation of vegetation or emboli. The clinical manifestations of infective endocarditis ie are variable.
Infective endocarditis european society of cardiology. Acute infective endocarditis aie is a difficult disease to suspect and diagnose. Diagnosis by 18ffdg petct of infective endocarditis. Jul 01, 2015 in the absence of classical features fever, cardiac murmur, and peripheral vascular stigmata the diagnosis of infective endocarditis ie may be difficult. The recently proposed duke criteria were confirmed to be more sensitive than the former beth israel criteria for the diagnosis of infective endocarditis ie. Infective endocarditis ie is an evolving disease with a persistently high mortality and morbidity, even in the modern era of advanced diagnostic imaging, improved antimicrobial chemotherapy, and. If both are positive, diagnosis is definite see evidence for exceptions. Proposed modifications to the duke criteria for the. The duke criteria should be used as overview of management of infective endocarditis in adults. Endocarditis modified duke criteria unclassified pacific partnership 2016 j am soc echocardiogr 2012. Coxiella burnetti infective endocarditis detection and cure.
Negative predictive value of the duke criteria for. The recommendations provided in this document are intended to assist in the management of this uncommon but potentially deadly infection. Finally, adjustment of the duke criteria to require a mini mum of 1 major plus 1 minor criterion or 3 minor criteria as a floor to designate a case. The duke criteria gave diagnostic weight to bacteremia with staphylococci or enterococci only, on the basis of the location of acquisition and with.
According to the duke criteria, diagnosis of infective endocarditis can be definite, possible, or rejected. Prosthetic valves and infective endocarditis duke university. Dx by duke criteria two major, one major plus three minor, or five minor criteria blood cultures are positive in 90% of ie cases and serologic testing is req in culture negative ie. Although the sensitivity and specificity of the duke criteria for the diagnosis of infective endocarditis ie have been validated by investigators from europe and the united states, several. Prevention the endocarditis team diagnosis definition of the terms used in the esc 2015 modified criteria for diagnosis of ie, with modifications in main principles of prevention of infective endocarditis boldface 1. Positive blood culture but not meeting major criteria or serologic evidence of active infection with organism consistet with ie definitive infective endocarditis ie. Positive blood culture for infective endocarditis ie. Baddour et al infective endocarditis in adults 1437 a diagnosis of ie with the original duke criteria was based on the presence of either major or minor clinical criteria tables 2 and 3. The diagnosis of infective endocarditis is made according to modified duke criteria, which are based on blood culture and echocardiographic findings.
Ralph corey, md, joseph kisslo, md, and the duke endocarditis service with use of new duke criteria, 405 episodes of sus. The modified duke criteria stratify patients into the following categories. Infective endocarditis ie is one of the first diagnostic. Value and limitations of the duke criteria for the diagnosis of infective. Modified dukes criteria for infective endocarditis. Modified duke criteria definite infective endocarditis clinical criteria 2 major criteria, or 1 major criterion and 3 minor criteria, or 5 minor criteria major criteria blood culture positive typical microorganism for ie multiple variations endocarditis by imaging study circulation 2005.
Infective endocarditis is a rare disease, with an incidence of two to six episodes per 100,000 habitantsyear. The duke criteria table 1,6 based upon clinical, echocardiographic and. Mobeen presents modified duke s criteria to diagnose definitively, or to suspect, or to. The most common cause of culturenegative endocarditis is antibiotic therapy preceding blood cultures.
The most common cause of infection was staphylococcus aureus in 28% of patients. Determine the appropriate laboratory tests and imaging necessary to aid in diagnosing ie. Beth israel criteria for the diagnosis of infective endocarditis ie. Duke criteria for infective endocarditis radiology.
The duke criteria for endocarditis are summarized below. Modified duke criteria incorporate patient risk factors, physical exam findings, laboratory studies, and echocardiographic imaging to diagnose. The causes and epidemiology of the disease have evolved in recent decades. It is the dedication of healthcare workers that will lead us through this crisis. Features indicating high risk for complications or need for surgery. Modified duke criteria for endocarditis university of pennsylvania. University of pennsylvania health system antimicrobial use. Current clinical guidelines for the diagnosis and management of ie recommend the use of modified duke criteria. After empirical antibiotics treatment for 3 days, the dog had no fever and showed typical heart sound intensity with normal ecg fig. Infective endocarditis an overview sciencedirect topics. Esc clinical practice guidelines aim to present all the relevant evidence to help physicians weigh the benefits and risks of a particular diagnostic or therapeutic procedure on infective endocarditis. In the absence of classical features fever, cardiac murmur, and peripheral vascular stigmata the diagnosis of infective endocarditis ie may be difficult. Appropriate use of transesophageal echocardiogram for.
Epidemiology, clinical manifestations, and diagnosis view in chinese contamination in the operating room. Criteria, definite infective endocarditis, possible infective endocarditis, not infective endocarditis. Give three examples of vascular sequelae of infective endocarditis 5. The presentation, clinical course, and approach to treatment can vary widely based on. Proposed modifications to the duke criteria for the diagnosis of infective endocarditis. Although the sensitivity and specificity of the duke criteria for the diagnosis of infective endocarditis ie have been validated by investigators from europe and the united states, several shortcomings of this schema remain. The duke ie database contains records collected prospectively on 800 cases of definite and possible ie since 1984. Duke criteria for infective endocarditis durack dt, lukes as, bright dk. Suspect ie and consider the duke criteria in patients with. Echocardiogram supportive of infective endocarditis.
Tee recommended as first test in the following patients. Modified duke s criteria for infective endocarditis. Ie may present as an acute, rapidly progressive rightsided native valve infective endocarditis view in chinese concomitant leftsided and rightsided ie account for approximately percent of all ie cases. Infective endocarditis ie is a rare, lifethreatening disease that has longlasting effects even among patients who survive and are cured.
Apr 01, 2014 2 after completing this article, readers should be able to. The accepted criteria for diagnosis of ie are the modified. Pdf proposed modifications to the duke criteria for the diagnosis. Give three examples of immunologic sequelae of infective endocarditis 4. The duke criteria for diagnosing infective endocarditis are specific. A wide variety of pathogens may cause infective endocarditis, and some cases are culture negative.
They should be essential in everyday clinical decision making. Guidelines for the diagnosis and antibiotic treatment of. Value and limitations of the duke criteria in the diagnosis of infective endocarditis. Value and limitations of the duke criteria for the diagnosis.
Infective endocarditis in a third trimester pregnant woman team work is the best option roxana botea, md,a jean porterie, md, bbertrand marcheix, md, phd,b franckolivier breleur, md, yoan laviebadie, mda abstract infective endocarditis in pregnancy may have a misleading presentation and carries a highrisk of complications for both. The modified duke criteria are used to help establish a diagnosis of endocarditis. The duke criteria for infective endocarditis provides standardized diagnostic criteria for endocarditis. Identification of staphylococcus pseudintermediu s in. Prevention the endocarditis team diagnosis definition of the terms used in the esc 2015 modified criteria for diagnosis of ie, with modifications in main principles of prevention of infective endocarditis boldface. Assesment of the duke criteria for the diagnosis of infective. Jun 30, 2018 acute infective endocarditis aie is a difficult disease to suspect and diagnose. Duke criteria perezvazquez a, farinas c, garcia palomo, et al. Infective endocarditis has an annual incidence of up to 10100,000 of the general population and carries a mortality of up to 30% at 30 days. Antibiotic treatment of infec tious endocarditis depends on whether the involved valve is native or. The diagnosis of infective endocarditis relies on the modified duke criteria which comprises microbiologic, echocardiographic, and clinicallaboratory criteria baddour lm, wilson wr, bayer as, fowler vg, tleyjeh im, rybak mj, et al. Infective endocarditis is a relatively uncommon disease with a high mortality rate. Evaluation of the duke criteria versus the beth israel criteria for the diagnosis of infective endocarditis. Infective endocarditis in a third trimester pregnant woman.
List the risk factors for infective endocarditis ie. Oct 22, 2017 echocardiography minor criteria eliminated predisposition heart condition or iv drug user microbiologic evidence positive blood culture but not meeting major criteria or serologic evidence of active infection with organism consistet with ie definitive infective endocarditis ie. Diagnostic criteria and problems in infective endocarditis. Diagnosis of infective endocarditis duke criteria empirically derived, retrospectively tested, prospectively validated has become standard for all current studies on infective endocarditis original data based solely on tte shortcomings of original criteria have led to recent proposed modifications. Major criteria can be met with positive blood cultures or serology for known pathogens, or echocardiogram changes consistent with endocarditis. Modified dukes criteria to diagnose acute infective. European association for cardiothoracic surgery eacts, the european association of nuclear medicine eanm authorstask force members.
Infective endocarditis is one of the leading causes of fever of unknown origin in those patients with intravascular catheters, prosthetic valves or cardiovascular implantable electronic devices. Assesment of the duke criteria for the diagnosis of. These transient ecg chang es may suggest diagnosis of infective. To compare the sensitivity of 3 different criteriavon reyn, duke, and modified. Chapter 83 infective endocarditis and valvular disease episode overview. Evaluation of the duke criteria in 93 episodes of prosthetic. Major criterion includes positive blood culture for typical infective endocarditis organisms, and echocardiogram with oscillating intracardiac mass. The duke diagnostic criteria have been validated in pathologically proven infective endocarditis, with sensitivity 80%8 and almost 100% specificity in patients with acute unexplained fever. Sep 15, 2015 infective endocarditis is a complex disease, and patients with this disease generally require management by a team of physicians and allied health providers with a variety of areas of expertise. Clinical criteria for definite endocarditis requires two major criteria, or one major and three minor criteria, or five minor criteria. For adequate diagnostic sensitivity, transesophageal echocardiography is the preferred modality used in patients. Ie disproportionately affects those with underlying. The incidence of infective endocarditis is between 3 and 10 episodes per 100,000 personyears with a peak incidence during the ages of 7080 of 14. Objectives the purpose of this study was to assess the value and limitations of duke criteria for the diagnosis of infective endocarditis ie.
The duke criteria are a set of clinical criteria set forward for the diagnosis of infective endocarditis. Duke criteria for diagnosing infective endocarditis are. The endocarditis diagnostic duke criteria calculator evaluates both major and minor diagnostic criteria. Negative predictive value of the duke criteria for infective endocarditis g.
Pdf although the sensitivity and specificity of the duke criteria for the diagnosis of infective endocarditis ie have been validated by. Infective endocarditis is a form of endocarditis, or inflammation, of the inner tissue of the heart such as its valves caused by infectious pathogens. Established in 1994 by the duke endocarditis service and revised in 2000, the duke criteria are a collection of major and minor criteria used to establish a diagnosis of infective endocarditis. Infective endocarditis ie is a noncontagious infection of the endocardium and heart valves. The epidemiology of ie has shifted recently with an increase in health careassociated ie. List 5 common bacteria responsible for infective endocarditis 3. Clinical criteria are 2 major, 1 major plus 3 minor or 5 minor criteria e. Infective endocarditis requiring intensive care unit stay is increasing, and nosocomial ie is frequently responsible. Infective endocarditis investigations bmj best practice. Pdf proposed modifications to the duke criteria for the. Duke criteria for the diagnosis of endocarditis definite. Endocarditis diagnostic criteria duke criteria calculator. Patients with infective endocarditis are a heterogenous group. New criteria for diagnosis of infective endocarditis.
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