DVT complete diagnostic approach resident survival guide

Positive Blood Culture for Infective Endocarditis

• Typical microorganism consistent with infective endocarditis from 2 separate blood cultures, in the absence of a primary focus:
  

❑ Viridans streptococci, streptococcus bovis

❑ HACEK group

❑ Community-acquired staphylococcus aureus

❑Enterococci

OR

• Microorganisms consistent with infective endocarditis from persistently positive blood cultures defined as:
  

❑ At least 2 positive cultures of blood samples drawn >12 hours apart, or

❑ All of 3 or a majority of 4 separate cultures of blood (with first and last sample drawn 1 hour apart)

• Single positive blood culture for Coxiella burnetii or anti–phase 1 IgG antibody titer >1:800

Echocardiographic evidence of endocardial involvement

❑ Oscillating intracardiac mass on valve or supporting structures, in the path of regurgitant jets, or on implanted material in the absence of an alternative anatomic explanation, or

❑ Abscess, or

❑ New partial dehiscence of prosthetic valve, or

❑ New valvular regurgitation

Minor criteria:

• Predisposition:

❑ Predisposing heart condition or intravenous drug use

• Fever:

❑ Temperature > 38.0° C (100.4° F)

• Vascular phenomena:

❑ Major arterial emboli

❑ Septic pulmonary infarcts

❑ Mycotic aneurysm

❑ Intracranial hemorrhage

❑ Conjunctival hemorrhage

❑ Janeway lesions

• Immunologic phenomena:

❑ Glomerulonephritis

❑ Osler's nodes

❑ Roth spots

❑ Rheumatoid factor

• Microbiological evidence:

❑ Positive blood culture but does not meet a major criterion as noted above, or

❑ Serological evidence of active infection with organism consistent with infectious endocarditis

Major criteria

Minor criteria

1- Positive Blood Culture for Infective Endocarditis ❑ Typical microorganism consistent with infective endocarditis from 2 separate blood cultures, in the absence of a primary focus: ❑ Viridans streptococci, streptococcus bovis ❑ HACEK group ❑ Community-acquired staphylococcus aureus ❑Enterococci OR ❑ Microorganisms consistent with infective endocarditis from persistently positive blood cultures defined as: ❑ At least 2 positive cultures of blood samples drawn >12 hours apart, or ❑ All of 3 or a majority of 4 separate cultures of blood (with first and last sample drawn 1 hour apart) OR ❑ Single positive blood culture for Coxiella burnetii or anti–phase 1 IgG antibody titer >1:800|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left 2-Echocardiographic evidence of endocardial involvement ❑ Oscillating intracardiac mass on valve or supporting structures, in the path of regurgitant jets, or on implanted material in the absence of an alternative anatomic explanation, or ❑ Abscess, or ❑ New partial dehiscence of prosthetic valve, or ❑ New valvular regurgitation

1- Predisposition ❑ Predisposing heart condition or intravenous drug use 2- Fever ❑ Temperature > 38.0° C (100.4° F) 3- Vascular phenomena ❑ Major arterial emboli ❑ Septic pulmonary infarcts ❑ Mycotic aneurysm ❑ Intracranial hemorrhage ❑ Conjunctival hemorrhage ❑ Janeway lesions 4- Immunologic phenomena ❑ Glomerulonephritis ❑ Osler's nodes ❑ Roth spots ❑ Rheumatoid factor 5- Microbiological evidence ❑ Positive blood culture but does not meet a major criterion as noted above, or ❑ Serological evidence of active infection with organism consistent with infectious endocarditis