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Assesment of the Duke criteria for the diagnosis of infective endocarditis after twenty-years. An analysis of 241 cases

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 a...

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Autores principales: TOPAN, ADRIANA, CARSTINA, DUMITRU, SLAVCOVICI, ADRIANA, RANCEA, RALUCA, CAPALNEANU, RADU, LUPSE, MIHAELA
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Iuliu Hatieganu University of Medicine and Pharmacy 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4632890/
https://www.ncbi.nlm.nih.gov/pubmed/26609264
http://dx.doi.org/10.15386/cjmed-469
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author TOPAN, ADRIANA
CARSTINA, DUMITRU
SLAVCOVICI, ADRIANA
RANCEA, RALUCA
CAPALNEANU, RADU
LUPSE, MIHAELA
author_facet TOPAN, ADRIANA
CARSTINA, DUMITRU
SLAVCOVICI, ADRIANA
RANCEA, RALUCA
CAPALNEANU, RADU
LUPSE, MIHAELA
author_sort TOPAN, ADRIANA
collection PubMed
description 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 IE: definite, possible and rejected. In order to evaluate the importance of each criterion in the diagnosis of IE we tested two hypotheses. First, we excluded each criterion from the final diagnosis and we counted how many cases felt into a lower category. Second, after adding each major and minor criterion, we tested how many cases would have been classifiable as definite IE. RESULTS: The study included 241 adult patients with a mean age 58.16 years and sex ratio male/female 1.94. According to the modified Duke criteria 137 patients had definite IE, 79 patients had possible IE and 25 cases had rejected IE We had blood cultures positive IE in 109 cases and blood culture negative IE (BCNE) in 132 (71.21%) cases. Antibiotic treatment prior to blood culture was recorded in 152 (63.07%) patients. In the absence of the echocardiography major criterion, 43% of cases would become possible. After extraction of major microbiological criterion, only one third of definite cases would become possible. Minor criteria such as fever and predisposition contributed to the diagnosis only in 10% of cases. In the presence of vascular or immunological phenomena, or in the presence of minor microbiological criterion, half of the possible IE cases could become possible. CONCLUSION: Twenty-years after their launch, the Duke criteria for the diagnosis of IE continue to be important tools. Low index of suspicion of IE and inappropriate use of antibiotics may have a great negative impact on the diagnosis of IE. Nowadays, the scarcity of classical Osler manifestations - bacteremia, fever and peripheral stigmata - makes the diagnosis of IE a challenge.
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spelling pubmed-46328902015-11-25 Assesment of the Duke criteria for the diagnosis of infective endocarditis after twenty-years. An analysis of 241 cases TOPAN, ADRIANA CARSTINA, DUMITRU SLAVCOVICI, ADRIANA RANCEA, RALUCA CAPALNEANU, RADU LUPSE, MIHAELA Clujul Med Original Research 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 IE: definite, possible and rejected. In order to evaluate the importance of each criterion in the diagnosis of IE we tested two hypotheses. First, we excluded each criterion from the final diagnosis and we counted how many cases felt into a lower category. Second, after adding each major and minor criterion, we tested how many cases would have been classifiable as definite IE. RESULTS: The study included 241 adult patients with a mean age 58.16 years and sex ratio male/female 1.94. According to the modified Duke criteria 137 patients had definite IE, 79 patients had possible IE and 25 cases had rejected IE We had blood cultures positive IE in 109 cases and blood culture negative IE (BCNE) in 132 (71.21%) cases. Antibiotic treatment prior to blood culture was recorded in 152 (63.07%) patients. In the absence of the echocardiography major criterion, 43% of cases would become possible. After extraction of major microbiological criterion, only one third of definite cases would become possible. Minor criteria such as fever and predisposition contributed to the diagnosis only in 10% of cases. In the presence of vascular or immunological phenomena, or in the presence of minor microbiological criterion, half of the possible IE cases could become possible. CONCLUSION: Twenty-years after their launch, the Duke criteria for the diagnosis of IE continue to be important tools. Low index of suspicion of IE and inappropriate use of antibiotics may have a great negative impact on the diagnosis of IE. Nowadays, the scarcity of classical Osler manifestations - bacteremia, fever and peripheral stigmata - makes the diagnosis of IE a challenge. Iuliu Hatieganu University of Medicine and Pharmacy 2015 2015-07-01 /pmc/articles/PMC4632890/ /pubmed/26609264 http://dx.doi.org/10.15386/cjmed-469 Text en This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/)
spellingShingle Original Research
TOPAN, ADRIANA
CARSTINA, DUMITRU
SLAVCOVICI, ADRIANA
RANCEA, RALUCA
CAPALNEANU, RADU
LUPSE, MIHAELA
Assesment of the Duke criteria for the diagnosis of infective endocarditis after twenty-years. An analysis of 241 cases
title Assesment of the Duke criteria for the diagnosis of infective endocarditis after twenty-years. An analysis of 241 cases
title_full Assesment of the Duke criteria for the diagnosis of infective endocarditis after twenty-years. An analysis of 241 cases
title_fullStr Assesment of the Duke criteria for the diagnosis of infective endocarditis after twenty-years. An analysis of 241 cases
title_full_unstemmed Assesment of the Duke criteria for the diagnosis of infective endocarditis after twenty-years. An analysis of 241 cases
title_short Assesment of the Duke criteria for the diagnosis of infective endocarditis after twenty-years. An analysis of 241 cases
title_sort assesment of the duke criteria for the diagnosis of infective endocarditis after twenty-years. an analysis of 241 cases
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4632890/
https://www.ncbi.nlm.nih.gov/pubmed/26609264
http://dx.doi.org/10.15386/cjmed-469
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