Infective endocarditis

[Durack DT et al. New criteria for diagnosis of IE. AM J Med 1994;206-209]

Diagnosis

1.Defenitive infective endocarditis
 1-1. Pathological criteria Microorganisms: demonstrated by culture or histology in a vegetation, or in a vegetation that has embolized, or in an intracardiac abscess, or

Pathological lesions: vegetaion or intracardiac abscess present, confirmed by histology showing active endocarditis
 1-2. Clinical criteria, using specific definitions listed below Two major criteria or
One major and three minor critria, or
Five minor criteria
2.Possible infective endocarditis
Findings consistent with infective andocarditis that fall short of definite endocarditis but are not rejected

3.Rejected
 Firm alternative diagnosis for manifestations of endocarditis, or
 Sustained resolution of manifestations of endocarditis with antibiotic therapy for 4 days or less or
 No pathological evidence of infective endocarditis at Surgery or autopsy, after antibitic therapy for 4days or less


Criteria

Major Criteria
Minor Criteria

Procedures for which prophylaxis against endocarditis is recommended

(recommendations for AHA ,1990)
Prophylaxis recomemendedNot recommended
Dental procedures known to induce gingival or mucosal bleeding, including professional cleaning and scaling
Tonsilelectomy or adenoidectomy
Surgery involving gastrointestinal or upper respiratory mucosa
Bronchoscopy wigh rigid bronchoscope
EIS(sclerotherapy for esophageal varices), esophageal dilation,
Gallbladder surgery
Cystoscopy, urethral dilation
Urethral catheterization if urinary infection is present
Urinary tract surgery, including prostate surgeryIncision and drainage of infected tissue
Vaginal hysterectomy
Vaginal delivery complicated by infecton
Dental procedures not likely to cause bleeding, such as adjustment or orthodontic appliances and simple fillings above the gum line
Intraoral injection or local anesthetic
Shedding of primary teeth
Tympanostomy tube insertion
Endotracheal tube insertion
Bronchoscopy with flexible bronchoscope, with or without biopsy
Cardiac cathterization
Gastrointestinal endoscopy, with or without biopsy
Cesarean section
In the absence of infection: Urethral catheterization, dilation and curettage, uncomplicated vaginal delivery, thrapeutic abortion, insertion or removal of intrauterine device, sterilization procedures, laparoscopy
(2001/5)