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Published on 01.07.2022
Current European guidelines recommend a multidisciplinary team approach in infective endocarditis in order to ensure adequate treatment and follow-up.
Major criteria | 1. Blood culture positive for infective endocarditis | ||
a. Typical microorganisms consistent with IE from 2 separate blood cultures | |||
• Viridans streptococci, Streptococcus gallolyticus (bovis), HACEK group, Staphylococcus aureus or | |||
• Community-acquired enterococci, in the absence of a primary focus or | |||
b. Microorganisms consistent with IE from persistently positive blood cultures: | |||
• ≥2 positive blood cultures of blood samples drawn >12h apart or | |||
• All of 3 or a majority of ≥4 separate cultures of blood (with first and last samples drawn ≥1 h apart); or | |||
c. Single positive blood culture for Coxiella burnetii or phase I IgG antibody titre >1:800 | |||
2. Imaging positive for IE | |||
a. Echocardiography positive for IE | |||
• Vegetation | |||
• Abscess, pseudoaneurysm, intracardiac fistula | |||
• Valvular perforation or aneurysm | |||
• New partial dehiscence of prosthetic valve | |||
b. Abnormal activity around the site of prosthetic valve implantation detected by 18F-FDG PET/ (only if the prosthesis was implanted for >3 months) or radiolabelled leukocytes SPECT/ | |||
c. Definite paravalvular lesions by cardiac CT | |||
Minor criteria | 1. Predisposing Heart conditions: previous IE, CHD, prosthetic valve, IVU | ||
2. Fever (> 38°C) | |||
3. Immunological findings: glomerulonephritis, Roth’s spots, Osler’s nodes and positive rheumatoid factor | |||
4. Vascular findings: arterial emboli, septic (mycotic) pulmonary infarcts, intracranial haemorrhage, conjunctival haemorrhages and Janeway’s lesions | |||
5. Microbiological evidence not meeting major criteria or serological evidence of active infection with organism consistent with IE |
Cardiogenic Shock / Heart Failure | Signs of heart failure with unstable haemodynamics (inotropic support, mechanical ventilation) |
Acute valvular regurgitation | |
Uncontrolled Infection | Abscesses, fistula or septic aneurysms |
Non-responders to antibiotic therapy | |
Neurology | Embolic events |
Ischaemic or haemorrhagic stroke | |
Prosthetic Valve Endocarditis | |
Cardiac-device related Endocarditis |
Indications for surgery | Timing | Class | Level |
1. Cardiogenic shock / heart failure | |||
Aortic or mitral NVE or PVE with severe acute regurgitation, obstruction or fistula causing refractory pulmonary oedema or cardiogenic shock | Emergency | I | B |
Aortic or mitral NVE or PVE with severe regurgitation or obstruction causing symptoms of heart failure or echocardiographic signs of poor haemodynamic tolerance | Urgent | I | B |
Uncontrolled infection | |||
Locally uncontrolled infection (abscess, false aneurysm, fistula, enlarging vegetation) | Urgent | I | B |
Infection caused by fungi or multiresistent organisms | Urgent/elective | I | C |
Persistent positive blood cultures despite appropriate antibiotic therapy and adequate control of septic metastatic foci | Urgent | IIa | B |
PVE caused by staphylococci or non-HACEK Gram-negative bacteria | Urgent/elective | IIa | C |
Prevention of embolism | |||
Aortic or mitral NVE or PVE with persistent vegetations >10 mm after one or more embolic episode despite appropriate antibiotic therapy | Urgent | I | B |
Aortic or mitral NVE with vegetations >10 mm, associated with severe valve stenosis or regurgitation, and low operative risk | Urgent | IIa | B |
Aortic or mitral NVE or PVE with isolated very large vegetations (>30 mm) | Urgent | IIa | B |
Aortic or mitral NVE or PVE with isolated large vegetations (>15 mm) and no other indication for surgery | Urgent | IIb | C |
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