Diagnosis-bacterial endocarditis

Modified Duke Criteria

(CID 2010;51:131; EHJ 2015;36:3075; Circ 2015;132:1435)

參考➡️ Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the …

• Blood cultures (before abx): 3 sets (aerobic & anaerobic bottles) from different sites, ideally spaced ≥1 h apart. ✓ BCx (at least 2 sets) after appropriate abx have been initiated to document clearance; repeat q24–48h until ⊖.

• Serial ECGs to assess for conduction disease and ↑ PR interval (c/f perivalvular abscess)

• echocardiogram as diagnosis of bacterial endocarditis

• transthoracic echo vs transesophageal echo in-Diagnosis-bacterial endocarditis

• Gated cardiac CT useful if TTE/TEE equivocal or suspected paravalvular abscess

• PET/CT using FDG useful for suspected PVE or CIED infxn if TTE/TEE equivocal

• Brain/spine imaging if concern for CNS spread (mycotic aneurysms, embolic stroke) or spinal involvement (vertebral osteo, epidural abscess)

• Cx ⊖ endocarditis: may be due to abx prior to BCx. PCR, bacterial 16S ribosomal RNA, serol. may be helpful. Detailed hx: animal exposure, travel, unpast. dairy, etc. ID eval. Consider organisms listed in Cx ⊖ footnote in microbiology table (vide supra).