ASSESMENT OF THE DUKE CRITERIA FOR THE DIAGNOSIS OF INFECTIVE ENDOCARDITIS AFTER TWENTY YEARS. AN ANALYSIS OF 241 CASES (original) (raw)
Related papers
Value and limitations of the duke criteria for the diagnosis of infective endocarditis
Journal of the American College of Cardiology, 1999
The purpose of this study was to assess the value and limitations of Duke criteria for the diagnosis of infective endocarditis (IE). BACKGROUND Duke criteria have been shown to be more sensitive in diagnosing IE than the von Reyn criteria, but the diagnosis of IE remains difficult in some patients. METHODS Both classifications were applied in 93 consecutive patients with pathologically proven IE. Blood cultures, and transthoracic and transesophageal echocardiography were performed in all patients. RESULTS Sensitivities for the diagnosis of IE were 56% and 76% for von Reyn and Duke criteria, respectively. Fifty-two patients were correctly classified as "probable IE" by von Reyn and "definite IE" by Duke criteria (group 1). However, discrepancies were observed in 41 patients. Eleven patients (group 2) were misclassified as "rejected" by von Reyn, but were "definite IE" by Duke criteria; this difference could be explained by negative blood cultures and positive echocardiogram in all patients. In eight patients (group 3), the diagnosis of IE was "possible" by von Reyn but "definite" by Duke criteria. This difference was essentially explained by the failure of the von Reyn classification to consider echocardiographic abnormalities as major criteria. Twenty-two patients (group 4) were misclassified as possible IE using Duke criteria, being false negative of this classification. Echocardiographic major criteria were present in 19 patients, but blood cultures were negative in 21 patients. The cause of negative blood cultures was prior antibiotic therapy in 11 patients and Q-fever endocarditis diagnosed by positive serology in three cases. CONCLUSIONS Twenty-four percent of patients with proved IE remain misclassified as "possible IE" despite the use of Duke criteria, especially in cases of culture-negative and Q-fever IE. Increasing the diagnostic value of echographic criteria in patients with prior antibiotic therapy and typical echocardiographic findings and considering the serologic diagnosis of Q fever as a major criterion would further improve the clinical diagnosis of IE.
Clujul Medical, 2015
Background and aims. In the absence of classical features (fever, cardiac murmur, and peripheral vascular stigmata) the diagnosis of infective endocarditis (IE) may be difficult.Current clinical guidelines for the diagnosis and management of IE recommend the use of modified Duke criteria. Correct and prompt diagnosis of IE is crucial for the treatment and outcome of the patients.The aim of this study was to evaluate the presence and the individual value of each criterion of the modified Duke criteria in our patients with infective endocarditis.Methods. We performed a prospective observational study between January 2008 – June 2014, in which we enrolled consecutive adult patients admitted for suspicion of IE to the Hospital of Infectious Diseases and at the Heart Institute . We used and extensive database in order to collect demographic data, laboratory and echocardiography results, evolution and outcome of the patients. Using the modified Duke criteria we identified 3 categories of ...
UPDATES TO THE DUKE CRITERIA FOR THE DIAGNOSIS OF INFECTIOUS ENDOCARDITIS: A REVIEW OF THE LITERATURE (Atena Editora), 2024
Goal: To investigate updates to the Duke Criteria for diagnosing infective endocarditis (EI). Methods: Bibliographic review conducted in the PubMed database using the specific search strategy ((duke criteria) AND (endocarditis)) AND ((diagnosis) OR (update) OR (management)). 18 articles selected from an initial total of 197 were analyzed. Discussion: The findings reveal an advance in the identification of IE, incorporating diverse populations, new microorganisms and imaging technologies. Methods such as cardiac PET-CT and three-dimensional transesophageal echocardiography have proven effective, highlighting persistent challenges, especially in patients with clinical suspicion of IE. Final considerations: Interdisciplinary collaborations are crucial to advance diagnostic accuracy, highlighting the importance of continuous research to improve diagnostic strategies and positively impact clinical practice and patients' lives.
Contribution of Systematic Serological Testing in Diagnosis of Infective Endocarditis
Journal of Clinical Microbiology, 2005
Despite progress with diagnostic criteria, the type and timing of laboratory tests used to diagnose infective endocarditis (IE) have not been standardized. This is especially true with serological testing. Patients with suspected IE were evaluated by a standard diagnostic protocol. This protocol mandated an evaluation of the patients according to the modified Duke criteria and used a battery of laboratory investigations, including three sets of blood cultures and systematic serological testing for Coxiella burnetii, Bartonella spp., Aspergillus spp., Legionella pneumophila, and rheumatoid factor. In addition, cardiac valvular materials obtained at surgery were subjected to a comprehensive diagnostic evaluation, including PCR aimed at documenting the presence of fastidious organisms. The study included 1,998 suspected cases of IE seen over a 9-year period from April 1994 to December 2004 in Marseilles, France. They were evaluated prospectively. A total of 427 (21.4%) patients were diagnosed as having definite endocarditis. Possible endocarditis was diagnosed in 261 (13%) cases. The etiologic diagnosis was established in 397 (93%) cases by blood cultures, serological tests, and examination of the materials obtained from cardiac valves, respectively, in 348 (81.5%), 34 (8%), and 15 (3.5%) definite cases of IE. Concomitant infection with streptococci and C. burnetii was seen in two cases. The results of serological and rheumatoid factor evaluation reclassified 38 (8.9%) possible cases of IE as definite cases. Systematic serological testing improved the performance of the modified Duke criteria and was instrumental in establishing the etiologic diagnosis in 8% (34/427) cases of IE.
Molecular Diagnosis of Infective Endocarditis: A Helpful Addition to the Duke Criteria
Clinical Medicine & Research, 2004
Infective endocarditis (IE) remains a disease of concern because of its relatively high morbidity and mortality if not treated aggressively. Its incidence rate is between 1.7 to 6.2 cases per 100,000 in the general population and has remained essentially unchanged in the last two decades. 1 Presently, there is a shift in the demographics of populations at risk, with IE being seen more often in intravenous drug users, 2 patients exposed to nosocomial settings, 3 and hemodialysis patients. 4 A number of review articles on IE are available for a detailed discussion of this topic. The current Duke classification criteria are used worldwide and are extremely useful in the diagnosis of native valve IE. These diagnostic guidelines include major and minor criteria, such as positive microbiological cultures, vegetations seen by echocardiography, fever, and the presence or absence of a predisposing heart condition. The Duke criteria have been found to be more sensitive than the von Reyn criteria in identifying IE cases as shown by Andrès et al. 9 in a study of 38 patients in a clinical internal medicine practice. The enhanced sensitivity was due to the incorporation of echocardiographic findings in the Duke criteria. However, the utility of the Duke criteria has not been adequately assessed in patients with proven or suspected prosthetic valve endocarditis (PVE) or in selected populations, such as patients with congenital heart disease, in patients on chronic dialysis, or in hospitalized patients with indwelling catheters and bacteremia. In a study by Ben-Ami et al., 8 the rate of hospital-associated IE was 27 cases per 100,000 persons, suggesting a broadening of the definition of hospital-acquired IE.