Infective endocarditis prophylaxis

I. DEFINITE ENDOCARDITIS

 

​A. Pathologic Criteria

 

     (1) Microorganisms identified in the context of clinical signs of active endocarditis in a vegetation; from cardiac tissue; from an explanted prosthetic valve or sewing ring; from an ascending aortic graft (with concomitant evidence of valve involvement); from an endovascular intracardiac implantable electronic device (CIED); or from an arterial embolus or

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     (2) Active endocarditis (may be acute or subacute/chronic ) identified in or on a vegetation; from cardiac tissue; from an explanted prosthetic valve or sewing ring; from an ascending aortic graft (with concomitant evidence of valve involvement); from a CIED; or from an arterial embolus

 

B. Clinical Criteria

 

     (1) 2 Major Criteria

                 or

     (2) 1 Major Criterion and 3 Minor Criteria

                 or

     (3) 5 Minor Criteria

 

II. POSSIBLE ENDOCARDITIS

 

        A. 1 Major Criterion And 1 Minor Criterion

                 or

        B. 3 Minor Criteria

 

III. REJECTED ENDOCARDITIS

 

         A. Firm alternate diagnosis explaining signs/symptoms or

         B. Lack of recurrence despite antibiotic therapy for less than 4 d. or

         C. No pathologic or macroscopic evidence of IE at surgery or autopsy, with antibiotic therapy for less than 4 d or

         D. Does not meet criteria for possible IE, as above

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Definitions of Infective Endocarditis According to the 2023 Duke-International Society for Cardiovascular Infectious Diseases Infective Endocarditis (IE) Criteria

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I. MAJOR CRITERIA

 

A. Microbiologic Major Criteria

 

(1) Positive blood cultures

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i. Microorganisms that commonly cause IE isolated from 2 or more separate blood culture sets (Typical) or

ii. Microorganisms that occasionally or rarely cause IE isolated from 3 or more separate blood culture sets (Nontypical) 

 

(2) Positive laboratory tests

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i. Positive polymerase chain reaction (PCR) or other nucleic acid-based technique for Coxiella burnetii, Bartonella species, or Tropheryma whipplei from blood or

ii. Coxiella burnetii antiphase I immunoglobulin G (IgG) antibody titer >1:800 , or isolated from a single blood culture or

iii. Indirect immunofluorescence assays (IFA) for detection of IgM and IgG antibodies to Bartonella henselae or Bartonella quintana with immunoglobulin G (IgG) titer ≥1:800

 

B. Imaging Major Criteria

 

(1) Echocardiography and cardiac computed tomography (CT) imaging

 

i. Echocardiography and/or cardiac CT showing vegetation,e valvular/leaflet perforation,f valvular/leaflet aneurysm, abscess, pseudoaneurysm, or intracardiac fistula or

ii. Significant new valvular regurgitation on echocardiography as compared with previous imaging. Worsening or changing of preexisting regurgitation is not sufficient. or

iii. New partial dehiscence of prosthetic valve as compared with previous imaging 

 

(2) Positron emission computed tomography with 18F-fluorodeoxyglucose ([18F]FDG PET/CT imaging) Abnormal metabolic activity involving a native or prosthetic valve, ascending aortic graft (with concomitant evidence of valve involvement), intracardiac device leads or other prosthetic material

 

C. Surgical Major Criteria

 

Evidence of IE documented by direct inspection during heart surgery neither Major Imaging Criteria nor subsequent histologic or microbiologic confirmation

 

II. MINOR CRITERIA

 

A. Predisposition – Previous history of IE – Prosthetic valve – Previous valve repair – Congenital heart disease – More than mild regurgitation or stenosis of any etiology – Endovascular intracardiac implantable electronic device (CIED) – Hypertrophic obstructive cardiomyopathy – Injection drug use

 

B. Fever Documented temperature greater than 38.0 °C (100.4 °F)

 

C. Vascular Phenomena Clinical or radiological evidence of arterial emboli, septic pulmonary infarcts, cerebral or splenic abscess, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, Janeway lesions, purulent purpura

 

D. Immunologic Phenomena Positive rheumatoid factor, Osler nodes, Roth spots, or immune complex-mediated glomerulonephritis

 

E. Microbiologic Evidence, Falling Short of a Major Criterion

 

1) Positive blood cultures for a microorganism consistent with IE but not meeting the requirements for Major Criterion or

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2) Positive culture, PCR, or other nucleic acid based test (amplicon or shotgun sequencing, in situ hybridization) for an organism consistent with IE from a sterile body site other than cardiac tissue, cardiac prosthesis, or arterial embolus; or a single finding of a skin bacterium by PCR on a valve or wire without additional clinical or microbiological supporting evidence 

 

F. Imaging Criteria Abnormal metabolic activity as detected by [18F]FDG PET/CT within 3 mo of implantation of prosthetic valve, ascending aortic graft (with concomitant evidence of valve involvement), intracardiac device leads or other prosthetic material

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G. Physical Examination Criteria New valvular regurgitation identified on auscultation if echocardiography is not available. Worsening or changing of preexisting murmur not sufficient

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Typical organism

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Staphylococcus aureus; Staphylococcus lugdunensis; Enterococcus faecalis

all streptococcal species (except for Streptococcus pneumoniae and Streptococcus pyogenes),

 

Granulicatella and Abiotrophia spp., Gemella spp., HACEK group microorganisms (Haemophilus species, Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae).

 

In the setting of intracardiac prosthetic material, the following additional bacteria should be included as “typical” pathogens:

 

coagulase negative staphylococci, Corynebacterium striatum and Corynebacterium jeikeium, Serratia marcescens, Pseudomonas aeruginosa, Cutibacterium acnes, nontuberculous mycobacteria (especially M. chimaerae), and Candida spp.

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