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Valvular heart diseases
New diagnostic approaches in infective endocarditis
  1. B Cherie Millar1,
  2. Gilbert Habib2,3,
  3. John E Moore1
  1. 1Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast, UK
  2. 2Aix-Marseille Université, Marseille, France
  3. 3Cardiology Department, APHM, La Timone Hospital, Marseille, France
  1. Correspondence to Dr B Cherie Millar, Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast BT9 7AD, UK; bcmillar{at}

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Learning objectives

  • To provide an overview of the current European Society of Cardiology guidelines and criteria, which are used in the diagnosis of infective endocarditis (IE), highlighting their advantages and limitations and to recognise the essential role played by a multidisciplinary team approach.

  • To understand the role molecular microbiological techniques play in aiding in the diagnosis of IE.

  • To appreciate the potential use and limitations of nuclear imaging, namely 18F-fluorodeoxyglucose-positron-emission tomography/CT, in diagnosing prosthetic valve IE, cardiac-device-associated IE and detection of secondary complications such as metastatic infection and embolic events.

Curriculum topic: infective endocarditis

Infective endocarditis (IE) has continued to be a serious cause of cardiac infection, associated with a poor prognosis and mortality.1 The incidence of IE ranges between 3 and 10 episodes each year/100 000, depending on geographical area and has been noted to increase dramatically with age, for example, 14.5 episodes each year/100 000 in patients between 70 and 80 years of age.2 Survival rates can be improved with an early and accurate diagnosis of this infection and its associated complications.1 Over the years, a number of diagnostic guidelines and criteria have been proposed, most notably the Von Reyn Criteria (1981), the initial Duke Criteria (1994), the universally accepted Modified Duke Criteria (2000) and most recently the European Society of Cardiology (ESC) 2015 modified criteria.3–7

Little is known about the historical epidemiology of IE >50 years ago; however, the relatively recent epidemiology of IE has changed in relation to the causative organisms, ‘at-risk-populations’ and the classification of the disease, most notably with the increased incidence of prosthetic valves and intracardiac devices.2 Recently through enhanced surveillance of IE, the International Collaboration on Endocarditis reported on the shift in the current microbiology of IE, whereby Staphylococcus aureus is now the primary causative agent (31% of cases), followed by viridans group streptococci (17% of …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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