Diagnostic (Duke) Criteria

•Definitive infective endocarditis

–pathologic criteria

•microorganisms or pathologic lesions: demonstrated by culture or histology in a vegetation, or in a vegetation that has embolized, or in an intracardiac abscess

–clinical criteria (see below)

•two major criteria, or one major and three minor criteria, or five minor criteria

Diagnostic (Duke) Criteria

•Possible infective endocarditis

–findings consistent of IE that fall short of “definite”, but not “rejected”

•Rejected

–firm alternate Dx for manifestation of IE

–resolution ofmanifestations of IE, with antibiotic therapy for 4 days

–no pathologic evidence of IE at surgery or autopsy, after antibiotic therapy for 4 days

Diagnostic (Duke) Criteria

•Major criteria

–positive blood culture for IE

–evidence of endocardial involvement

•Minor criteria

–predisposition (heart condition or IV drug use)

–fever of 100.40F or higher

–vascular or immunologic phenomena

–microbiologic or echocardiographic evidence not meeting major criteria

Duke’s Major Criteria

•positive blood culture for IE

–typical microorganism (strep viridans, strep bovis, HACEK group, staph aureus or enterococci in the absence of a primary locus) for endocarditis from two separate blood cultures

–persistently positive blood culture from:

•blood cultures drawn more than 12 hr apart, or

•all of 3 or a majority of 4 or more separate blood cultures, with first and last drqwn at least 1 hr apart

Duke’s Major Criteria

•Evidence of endocardial involvement

–positive echocardiogram for endocarditis

•oscillating intracardiac mass on valve or supporting structure, or in the path of regurgitant jets, or on implanted material, in the absence of an alternate anatomic explanation

•abscess

•new partial dehiscence of prosthetic valve

–new valvular regurgitation (increase or change in pre-existing murmur not sufficient)

Duke’s Minor Criteria

•predisposition (predisposing heart condition or iv drug use)

•fever of 100.40F or higher

•vascular phenomena (major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctive hemorrhages, Janeway lesions)

Duke’s Minor Criteria

•immunologic phenomena (glomerulonephritis, Osler’s nodes, Roth spots, rheumatoid factor)

•microbiologic evidence (positive blood culture not meeting major criteria or serologic evidence of active infection with organism consistent with IE)

•echocardiogram (consistent with IE but not meeting major criteria)

Risk for Endocarditis

•High risk

–prosthetic cardiac valve

–prior episodes of endocarditis

–complex congenital cardiac defect

–surgically constructed systemic- pulmonary shunts or conduits

Risk for Endocarditis

•Moderate risk

–patent ductus arteriosus

–VSD, primum ASD

–coarctation of the aorta

–bicuspid aortic valve

–hypertrophic cardiomyopathy

–acquired valvular dysfunction

–MVP with mitral regurgitation

Risk for Endocarditis

•Low risk

–isolated secundum atrial septal defect

–ASD, VSD, or PDA >6 months past repair

–“innocent” heart murmur by auscultation in the pediatric population

–“innocent” heart murmur by echocardiography in adult patients