Remember that Lack of Positive Blood Cultures does not Rule Out Bacterial Endocarditis



Remember that Lack of Positive Blood Cultures does not Rule Out Bacterial Endocarditis


Harjot K. Singh MD

Aruna K. Subramanian MD



Infective endocarditis (IE) is generally defined by vegetative cardiac lesions in the setting of positive blood cultures. However, the lack of a single diagnostic test has led to several diagnostic algorithms, of which the Duke criteria are the most widely accepted. The Duke criteria have been shown to have a specificity of 99% and a negative predictive value of 92%. Despite the diagnostic difficulty, when infective endocarditis is suspected, empiric therapy is warranted because of its high morbidity and mortality.


Signs and Symptoms

The signs and symptoms of infective endocarditis can vary greatly and have a low sensitivity and specificity for infective endocarditis. Fevers, chills, and sweats are common. Fatigue, syncope, congestive heart failure, and embolic events can occur. On exam, patients can have fever, new or louder pre-existent murmurs, splinter hemorrhages, Janeway lesions, Osler nodes, or Roth spots. Risk factors endocarditis include presence of prosthetic valves, structural heart disease, intravenous drug use, and indwelling catheters.

Definitive diagnosis using the Duke criteria requires fulfillment of two major criteria, one major and three minor, or five minor criteria.


Major Criteria

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Jul 1, 2016 | Posted by in ANESTHESIA | Comments Off on Remember that Lack of Positive Blood Cultures does not Rule Out Bacterial Endocarditis

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