Duke criteria for infective endocarditis durack dt, lukes as, bright dk. Greatest morbidity occurs among those with recent cardiac prostheses, statuspost heart transplant, or prior endocarditis. Acute infective endocarditis aie is a difficult disease to suspect and diagnose. Appropriate use of transesophageal echocardiogram for. Clinical criteria are 2 major, 1 major plus 3 minor or 5 minor criteria e. According to the duke criteria, diagnosis of infective endocarditis can be definite, possible, or rejected. The term predisposing heart condition is used as an indication of antimicrobial prophylaxis to prevent infective endocarditis ie and as a criterion for diagnosing ie according to modified duke criteria. 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. The duke diagnostic criteria, developed by durack and colleagues, are generally used to make a definitive diagnosis of ie. Many studies have now demonstrated the superiority of the duke.
Endocarditis modified duke criteria unclassified pacific partnership 2016 j am soc echocardiogr 2012. List the risk factors for infective endocarditis ie. Tee recommended as first test in the following patients. Guidelines for the diagnosis and antibiotic treatment of endocarditis in adults. The duke criteria for endocarditis are summarized below. Duke criteria for infectious endocarditis diagnosis. Major criterion includes positive blood culture for typical infective endocarditis organisms, and echocardiogram with oscillating intracardiac mass.
The duke criteria for infective endocarditis provides standardized diagnostic criteria for endocarditis. A wide variety of pathogens may cause infective endocarditis, and some cases are culture negative. Endocarditis diagnostic criteria modified duke criteria. The duke criteria table 1,6 based upon clinical, echocardiographic and microbiological. Infective endocarditis ie refers to infection of the endocardial surface of the heart.
University of pennsylvania health system antimicrobial use. Despite improved medical and surgical advances, the. What is the role of the duke diagnostic criteria in. 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. Patients with infective endocarditis are a heterogenous group. The duke criteria are a set of clinical criteria set forward for the diagnosis of infective endocarditis. Modified dukes criteria for infective endocarditis. Recognize the signs, symptoms, and duke criteria that aid in the diagnosis of ie. Evaluation of the duke criteria in 93 episodes of prosthetic. Proposed modifications to the duke criteria for the diagnosis of infective endocarditis. Many studies have now demonstrated the superiority of. Retrospective case study in a tertiary pediatric hospital. Patients were identified prospectively over a 3year period at 54 hospitals in the philadelphia metropolitan area. The duke criteria gave diagnostic weight to bacteremia with staphylococci or enterococci only, on the basis of the location of acquisition and with.
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 duke criteria should be used as overview of management of infective endocarditis in adults. The criteria combine the clinical, microbiologic, pathologic, and. The most common cause of infection was staphylococcus aureus in 28% of patients. The duke ie database contains records collected prospectively on 800 cases of definite and possible ie since 1984. For adequate diagnostic sensitivity, transesophageal echocardiography is the preferred modality used in patients. Positive blood culture for typical infective endocarditis organisms s. In the absence of classical features fever, cardiac murmur, and peripheral vascular stigmata the diagnosis of infective endocarditis ie may be difficult. 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. Pathologic criteria are histological or culture confirmation ofpathologic criteria are histological or culture confirmation of vegetation or emboli.
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. The modified duke criteria stratify patients into the following categories. 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. To compare the sensitivity of 3 different criteriavon reyn, duke, and modified dukein diagnosing infective endocarditis ie in children. The presentation, clinical course, and approach to treatment can vary widely based on. Click on the image or right click to open the source website in a new browser window.
Modified dukes criteria to diagnose acute infective. The purpose of this survey was to elaborate clinicians knowledge and opinion on relevant heart conditions as a duke minor criterion for the diagnosis of ie. They should be essential in everyday clinical decision making. We evaluated the usefulness of the duke criteria for diagnosing cases of active infective endocarditis ie. New criteria for diagnosis of infective endocarditis. Minor criterion includes predisposing heart condition or iv drug use, fever, vascular phenomena, immunologic phenomena, microbiological. 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. The duke criteria for the diagnosis of endocarditis include either two major criteria i. Suspect ie and consider the duke criteria in patients with. Determine the appropriate laboratory tests and imaging necessary to aid in diagnosing ie. Diagnostic criteria and problems in infective endocarditis.
These were originally proposed in 1994 to help establish the diagnosis of endocarditis. Infective endocarditis is a relatively uncommon disease with a high mortality rate. Many studies have now demonstrated the superiority of the duke criteria and a recent scientific statement of the american heart association concluded that they should be adopted as the primary diagnostic schema in the clinical evaluation of patients in whom infective endocarditis is suspected. These images are a random sampling from a bing search on the term duke criteria for infectious endocarditis diagnosis. Pdf proposed modifications to the duke criteria for the. Assessment of the usefulness of the duke criteria for. Mobeen presents modified dukes criteria to diagnose definitively, or to suspect, or to. Duke criteria perezvazquez a, farinas c, garcia palomo, et al. 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. Endocarditis continues to have a high mortality, estimated at 1020% among hospitalized patients. European association for cardiothoracic surgery eacts, the european association of nuclear medicine eanm. Guidelines for the diagnosis and antibiotic treatment of.
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. Between 1985 and 2001, 41 episodes of ie were documented in 40 children median. Clinical criteria for definite endocarditis requires two major criteria, or one major and three minor criteria, or five minor criteria. The endocarditis diagnostic duke criteria calculator evaluates both major and minor diagnostic criteria. Infective endocarditis an overview sciencedirect topics. It is the dedication of healthcare workers that will lead us through this crisis. Echocardiogram supportive of infective endocarditis. The accepted criteria for diagnosis of ie are the modified. Duke criteria for infective endocarditis radiology.
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