The duke criteria should be used as overview of management of infective endocarditis in adults. Acute infective endocarditis aie is a difficult disease to suspect and diagnose. Ralph corey, md, joseph kisslo, md, and the duke endocarditis service with use of new duke criteria, 405 episodes of sus. 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. Positive blood culture for infective endocarditis ie. Current clinical guidelines for the diagnosis and management of ie recommend the use of modified duke criteria. The duke criteria for endocarditis are summarized below. 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. Identification of staphylococcus pseudintermediu s in.
Major criterion includes positive blood culture for typical infective endocarditis organisms, and echocardiogram with oscillating intracardiac mass. Infective endocarditis european society of cardiology. Infective endocarditis in a third trimester pregnant woman. Value and limitations of the duke criteria for the diagnosis. Duke criteria for diagnosing infective endocarditis are.
Jun 30, 2018 acute infective endocarditis aie is a difficult disease to suspect and diagnose. These were originally proposed in 1994 to help establish the diagnosis of endocarditis. The modified duke criteria stratify patients into the following categories. Infective endocarditis ie is one of the first diagnostic. Endocarditis diagnostic criteria duke criteria calculator. Pathologic criteria are histological or culture confirmation ofpathologic criteria are histological or culture confirmation of vegetation or emboli.
Aha scientific statement on infective endocarditis 2015. Chapter 83 infective endocarditis and valvular disease. 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. Ie disproportionately affects those with underlying. The duke criteria for infective endocarditis provides standardized diagnostic criteria for endocarditis.
Appropriate use of transesophageal echocardiogram for. Modified duke criteria for endocarditis university of pennsylvania. A wide variety of pathogens may cause infective endocarditis, and some cases are culture negative. Evaluation of the duke criteria in 93 episodes of prosthetic. Infective endocarditis is a relatively uncommon disease with a high mortality rate. Value and limitations of the duke criteria in the diagnosis of infective endocarditis. Modified duke criteria incorporate patient risk factors, physical exam findings, laboratory studies, and echocardiographic imaging to diagnose. Healthcare related infections now account for 2530% of newly reported cases of endocarditis. Modified dukes criteria to diagnose acute infective. The endocarditis diagnostic duke criteria calculator evaluates both major and minor diagnostic criteria. To compare the sensitivity of 3 different criteriavon reyn, duke, and modified. Infective endocarditis an overview sciencedirect topics.
The diagnosis of infective endocarditis is made according to modified duke criteria, which are based on blood culture and echocardiographic findings. List the risk factors for infective endocarditis ie. The recommendations provided in this document are intended to assist in the management of this uncommon but potentially deadly infection. Endocarditis modified duke criteria unclassified pacific partnership 2016 j am soc echocardiogr 2012. University of pennsylvania health system antimicrobial use. 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.
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. 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. 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. 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.
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. Positive blood culture but not meeting major criteria or serologic evidence of active infection with organism consistet with ie definitive infective endocarditis ie. According to the duke criteria, diagnosis of infective endocarditis can be definite, possible, or rejected. Assesment of the duke criteria for the diagnosis of infective. The duke ie database contains records collected prospectively on 800 cases of definite and possible ie since 1984. In the absence of classical features fever, cardiac murmur, and peripheral vascular stigmata the diagnosis of infective endocarditis ie may be difficult. Determine the appropriate laboratory tests and imaging necessary to aid in diagnosing 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. Beth israel criteria for the diagnosis of infective endocarditis ie. Antibiotic treatment of infec tious endocarditis depends on whether the involved valve is native or. The causes and epidemiology of the disease have evolved in recent decades. Echocardiogram supportive of infective endocarditis.
Clinical criteria are 2 major, 1 major plus 3 minor or 5 minor criteria e. 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. Negative predictive value of the duke criteria for. New criteria for diagnosis of infective endocarditis. Patients with infective endocarditis are a heterogenous group. 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. Pdf although the sensitivity and specificity of the duke criteria for the diagnosis of infective endocarditis ie have been validated by. The duke criteria gave diagnostic weight to bacteremia with staphylococci or enterococci only, on the basis of the location of acquisition and with. Mobeen presents modified duke s criteria to diagnose definitively, or to suspect, or to. Main complications of leftsided valve ie and their management. Give three examples of vascular sequelae of infective endocarditis 5. Infective endocarditis ie is a noncontagious infection of the endocardium and heart valves. Proposed modifications to the duke criteria for the.
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. 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. 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. Diagnosis by 18ffdg petct of infective endocarditis. Recognize the signs, symptoms, and duke criteria that aid in the diagnosis of ie. Duke criteria for infective endocarditis durack dt, lukes as, bright dk. The duke criteria table 1,6 based upon clinical, echocardiographic and. The presentation, clinical course, and approach to treatment can vary widely based on. The agents are usually bacterial, but other organisms can also be responsible. Coxiella burnetti infective endocarditis detection and cure. Negative predictive value of the duke criteria for infective endocarditis g.
Infective endocarditis investigations bmj best practice. They should be essential in everyday clinical decision making. The duke criteria for diagnosing infective endocarditis are specific. Duke criteria for the diagnosis of endocarditis definite. If both are positive, diagnosis is definite see evidence for exceptions. Diagnostic criteria and problems in infective endocarditis. The most common cause of infection was staphylococcus aureus in 28% of patients. Value and limitations of the duke criteria for the diagnosis of infective. The clinical manifestations of infective endocarditis ie are variable. These transient ecg chang es may suggest diagnosis of infective.
European association for cardiothoracic surgery eacts, the european association of nuclear medicine eanm authorstask force members. Features indicating high risk for complications or need for surgery. Infective endocarditis adult inpatient clinical practice. The accepted criteria for diagnosis of ie are the modified. The epidemiology of ie has shifted recently with an increase in health careassociated ie. Evaluation of the duke criteria versus the beth israel criteria for the diagnosis of infective endocarditis. Epidemiology, clinical manifestations, and diagnosis view in chinese contamination in the operating room.
After empirical antibiotics treatment for 3 days, the dog had no fever and showed typical heart sound intensity with normal ecg fig. Infective endocarditis ie is a rare, lifethreatening disease that has longlasting effects even among patients who survive and are cured. Proposed modifications to the duke criteria for the diagnosis of infective endocarditis. The recently proposed duke criteria were confirmed to be more sensitive than the former. 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. 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. Infective endocarditis is a rare disease, with an incidence of two to six episodes per 100,000 habitantsyear. For adequate diagnostic sensitivity, transesophageal echocardiography is the preferred modality used in patients. 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. 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. List 5 common bacteria responsible for infective endocarditis 3. Minor criteria are a predisposing heart condition or intravenous drug use, a fever, vascular or immunologic phenomena, or blood culture or. 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.
Duke criteria perezvazquez a, farinas c, garcia palomo, et al. 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. Give three examples of immunologic sequelae of infective endocarditis 4. Modified duke s criteria for infective endocarditis. Guidelines for the diagnosis and antibiotic treatment of. Major criteria can be met with positive blood cultures or serology for known pathogens, or echocardiogram changes consistent with endocarditis. The duke criteria are a set of clinical criteria set forward for the diagnosis of infective endocarditis. 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. Apr 01, 2014 2 after completing this article, readers should be able to. Clinical criteria for definite endocarditis requires two major criteria, or one major and three minor criteria, or five minor criteria. Pdf proposed modifications to the duke criteria for the diagnosis. Infective endocarditis requiring intensive care unit stay is increasing, and nosocomial ie is frequently responsible.
Infective endocarditis is a form of endocarditis, or inflammation, of the inner tissue of the heart such as its valves caused by infectious pathogens. The recently proposed duke criteria were confirmed to be more sensitive than the former beth israel criteria for the diagnosis of infective endocarditis ie. It is the dedication of healthcare workers that will lead us through this crisis. Tee recommended as first test in the following patients. 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. Pdf proposed modifications to the duke criteria for the. Modified dukes criteria for infective endocarditis. The most common cause of culturenegative endocarditis is antibiotic therapy preceding blood cultures. Objectives the purpose of this study was to assess the value and limitations of duke criteria for the diagnosis of infective endocarditis ie. Chapter 83 infective endocarditis and valvular disease episode overview. Suspect ie and consider the duke criteria in patients with. Criteria, definite infective endocarditis, possible infective endocarditis, not infective endocarditis. The modified duke criteria are used to help establish a diagnosis of endocarditis.