ESC 2015 modified criteria for the diagnosis of infective endocarditis
From IDWiki
Background
- Used to diagnose infective endocarditis
- Recommended when the modified Duke criteria are possible or rejected, but with high clinical suspicion
- Repeat the echo
- Look for imaging evidence of embolic phenomena, such as MRI brain, whole body CT, or PET/CT
- Consider specialized imaging like cardiac CT, PET/CT, or white cell SPECT/CT
- Compared to modified Duke criteria, the ESC criteria add the following:
- Paravalvular lesions detected by cardiac CT
- Abnormal activity around a prosthetic valve detected by 18F-FDG PET/CT or radiolabelled leukocyte SPECT/CT
- Detection of embolic phenomena by imaging
Criteria
Major Criteria
- Blood cultures positive for IE
- Typical microorganisms consistent with IE from 2 separate blood cultures
- Viridans group streptococci, Streptococcus gallolyticus (Streptococcus bovis), HACEK group, Staphylococcus aureus; or
- Community-acquired enterococci, in the absence of a primary focus; or
- Microorganisms consistent with IE from persistently positive blood cultures
- ≥2 positive blood cultures of blood samples drawn more than 12 hours apart; or
- All of 3 or a majority of ≥4 separate cultures of blood with first and last samples drawn at least 1 hour apart; or
- Single positive blood culture for Coxiella burnetii or phase I IgG antibody titre greater than 1:800
- Typical microorganisms consistent with IE from 2 separate blood cultures
- Imaging positive for IE
- Echocardiogram positive for IE
- Vegetation
- Abscess, pseudoaneurysm, or intracardiac fistula
- Valvular perforation or aneurysm
- New partial dehiscence of prosthetic valve
- Abnormal activity around the site of prosthetic valve implantation detected by 18F-FDG PET/CT (only if the prosthesis was implanted for greater than 3 months) or radiolabelled leukocytes SPECT/CT
- Definite paravalvular lesions by cardiac CT
- Echocardiogram positive for IE
Minor Criteria
- Predisposition, such as predisposing heart condition or injection drug use
- Fever with temperature >38ºC
- Vascular phenomena, including those detected by imaging only: major arterial emboli, septic pulmonary infarcts, infection/mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, and Janeway lesions
- Immunological phenomena: glomerulonephritis, Osler nodes, Roth spots, positive rheumatoid factor
- Microbiologic evidence: positive blood culture that does not meet a major criteria, or serological evidence of active infection with an organism consistent with IE
