Native-valve endocarditis detected by point-of-care echocardiography

The Ultrasound Journal

Table 1 Clinical criteria for the diagnosis of infective endocarditis [2, 3]

Major criteria
Positive blood cultures for IE	Typical microorganisms consistent with IE from 2 separate blood cultures: • Viridans streptococci, Streptococcus bovis, HACEK group, Staphylococcus aureus; or • Community-acquired enterococci, in the absence of a primary focus; or Microorganisms consistent with IE from persistently positive blood cultures, defined as follows: • At least 2 positive cultures of blood samples drawn > 12 h apart; or • All of 3 or a majority of > 4 separate cultures of blood (with first and last sample drawn at least 1 h apart) Single positive blood culture for Coxiella burnetii or antiphase I IgG antibody titer > 1: 800
Positive echocardiographic findings of IE	Vegetation, perivalvular abscess, new dehiscence of a prosthetic valve
New valvular regurgitation (heart murmur)

Minor criteria
Predisposing heart condition or injection drug use
Fever (> 38 °C; > 100.4°F)
Vascular phenomena	Major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, Janeway lesions
Immunologic phenomena	Glomerulonephritis, Osler’s nodes, Roth spots, positive rheumatoid factor
Blood cultures non-compatible with major criteria	Positive blood culture but not meeting major criterion as noted previously or serologic evidence of active infection with organism consistent with IE
Minor echocardiographic criteria	Non-oscillating targets, new valvular fenestrations, nodular valve thickening

IE infective endocarditis; HACEK Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species; The diagnosis of infective endocarditis (clinical definition) is definite when 2 major criteria, or 1 major criterion and 3 minor criteria, or 5 minor criteria are meet; IE possible when neither non-definite nor rejected-criteria are meet; IE rejected when a firm alternate diagnosis of endocarditis is meet, or resolution of symptoms is achieved with antibiotic therapy for 4 days or less [2, 3]