Infective Endocarditis Treatment

Criteria for diagnosis of Endocarditis

Criteria used are from ESC 2015 modified criteria and 2023 update, table 56

Definite IE:

·         Pathological criteria:

• o   Microorganisms demonstrated by culture or on histological examination of a vegetation, a vegetation that has embolised, or an intracardiac abscess specimen;
• o   or Pathological lesions; vegetation or intracardiac abscess by histological examination showing active endocarditis

·         Clinical criteria:  

• o   2 major criteria;
• o   or 1 major criterion and 3 minor criteria;
• o   or 5 minor criteria

Major criteria:

1. Blood cultures positive for S. aureus
2. Imaging positive for IE:

1. Echo-cardiogram positive for IE: including vegetation, abscess, pseudo-aneurysm, intra-cardiac fistula, valvular perforation or aneurysm, or new partial dehisence of prosthetic valve.
2. Abnormal activity around the site of prosthetic valve implantation detected by 18F-FDG PET/CT (only if the prosthesis was implanted for >3 months) or radiolabelled leukocytes SPECT/CT
3. Definite para-valvular lesions by cardiac CT

Minor criteria:

1. Predisposition such as predisposing heart condition, or injection drug use.
2. Fever defined as temperature >38°C.
3. Vascular phenomena (including those detected by imaging only): Major arterial emboli, septic pulmonary infarcts, infectious (mycotic) aneurysm, intracranial haemorrhage, conjunctival haemorrhages, and Janeway’s lesions.
4. Immunological phenomena: glomerulonephritis, Osler’s nodes, Roth’s spots, and rheumatoid factor.
5. Microbiological evidence: positive blood culture but does not meet a major criterion as noted above