Version October 2024
| Definite endocarditis |
| Pathologic criteria |
| 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 Active endocarditis¶ (may be acuteΔ 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 embolus |
| Clinical criteria |
| 2 major criteria or 1 major criterion and 3 minor criteria or 5 minor criteria |
| Possible endocarditis |
| 1 major criterion and 1 minor criterion or 3 minor criteria |
| Rejected endocarditis |
| Firm alternate diagnosis explaining signs/symptoms§ or Lack of recurrence despite antibiotic therapy for less than 4 days or No pathologic or macroscopic evidence of IE at surgery or autopsy, with antibiotic therapy for less than 4 days or Does not meet criteria for possible IE, as above |
IE: infective endocarditis; PASD: periodic acid-Schiff with diastase; PCR: polymerase chain reaction.
* By culture, staining, immunologic techniques, PCR or other nucleic acid-based tests including amplicon (16S, 18S, internal transcribed spacers) sequencing, metagenomic (shotgun) sequencing, or in situ hybridization on fresh or paraffin-fixed tissue. Molecular techniques and tissue staining (Gram stain, PASD, Grocott, or silver stains such as Warthin-Starry, Steiner, or Dieterle) should be interpreted cautiously, particularly in patients with a prior episode of IE because such tests can remain positive for extended periods following successful treatment. Antibiotic therapy before tissue procurement may also significantly alter microorganism morphology and staining characteristics. Test specificity is influenced by several factors, and false positives can occur. Test interpretation should always be in the context of clinical and histological evidence of active endocarditis. A single finding of a skin bacterium by PCR on a valve or wire without additional clinical or microbiological supporting evidence should be regarded as minor criterion and not definite IE.
¶ Active endocarditis: Vegetations, leaflet destruction, or adjacent tissue of native or prosthetic valves showing variable degrees of inflammatory cell infiltrates and healing. Many specimens demonstrate mixed features.
Δ Acute endocarditis: Vegetations or cardiac/aortic tissue lesions of native or prosthetic valves showing active inflammation without significant healing or organizational change.
◊ Subacute or chronic endocarditis: Vegetations or cardiac/aortic tissue lesions of native or prosthetic valves demonstrating evidence of healing or attempted healing: maturing granulation tissue and fibrosis showing variable mononuclear cell infiltration and/or calcification. Calcification can occur rapidly in injured tissue and vegetations, or be part of the underlying valvular disease that was the original nidus for IE.
§ Firm alternate diagnosis explaining IE signs and symptoms consists of either microbiologic or nonmicrobiologic causes. Firm alternate microbiologic diagnosis includes a) identifiable source for bloodstream infection with a nontypical IE pathogen; b) rapid resolution of bloodstream infection; and c) absence of evidence for IE on cardiac imaging. Firm alternate nonmicrobiologic diagnosis includes a) presence of non-IE cause for cardiac imaging findings (eg, marantic or nonbacterial thrombotic endocarditis); and b) absence of microbiologic evidence for IE.Do you want to add Medilib to your home screen?
