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Infective Endocarditis

Dr Swapnil Pawar May 2, 2021 15


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    Infective Endocarditis
    Dr Swapnil Pawar

Written by Dr Andrew Lam

Infective Endocarditis

Modified Duke’s Criteria

Infective Endocarditis can be definitively diagnosed in the presence of:

2 Major Criteria, OR

1 Major and 3 Minor Criteria, OR

5 Minor Criteria

Major Criteria: 

  • Micro-Organisms consistent with IE isolated from 2 separate blood cultures 
  • Evidence of myocardial involvement (i.e. Echocardiogram positive for IE or new valvular regurgitation)

Minor Criteria: 

  • Temperature (>38°C)
  • Predisposing Risk Factors (i.e. IV Drug Use, prosthetic heart valve)
  • Vascular Phenomena (arterial embolisation, septic pulmonary infarction, mycotic aneurysm, Janeway lesions)
  • Immunological Phenomena (i.e. glomerulonephritis, Osler’s Nodes, Roth Spots)
  • Positive blood cultures that do not meet major criteria

Risk Factors

  • IV Drug Use (promotes bacterial seeding, typically affects tricuspid valve)
  • Poor dentition or recent dental surgery
  • Structural heart disease (i.e. HOCM, VSD, aortic coarctation, congenital or acquired valvular disease)
  • Prosthetic heart valves 
  • Intravascular Devices (i.e. central venous catheters, pacemakers, ICD’s)

Complications

Local Complications

  • Heart failure (right or left dependent on valve involved)
  • A perivalvular abscess (Can result in conduction blocks/arrhythmias)
  • Pericarditis

Systemic Complications

  • Septic Arterial Embolisation (stroke, splenic/renal infarction, myocardial infarction, pulmonary embolism)
  • Metastatic Abscess (secondary to septic embolisation
  • Mycotic Aneurysm (usually at points of vessel bifurcation)
  • Osteomyelitis or Septic Arthritis
  • Glomerulonephritis (immune complex-mediated)

References: 

Sexton, D.J., Chu, V.H., (2020). Clinical manifestations and evaluation of adults with suspected left-sided native valve endocarditis. UpToDate. Retrieved May 1, 2021, from https://www.uptodate.com.acs.hcn.com.au/contents/clinical-manifestations-and-evaluation-of-adults-with-suspected-left-sided-native-valve-endocarditis

Sexton, D.J., Chu, V.H., (2021). Native valve endocarditis: Epidemiology, risk factors, and microbiology. UpToDate. Retrieved May 1, 2021, from https://www.uptodate.com.acs.hcn.com.au/contents/native-valve-endocarditis-epidemiology-risk-factors-and-microbiology

Spelman, D., (2021). Complications and outcome of infective endocarditis. UpToDate. Retrieved May 1, 2021, from https://www.uptodate.com.acs.hcn.com.au/contents/complications-and-outcome-of-infective-endocarditis

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