Definition of infective endocarditis according to the proposed modified Duke criteria. a

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... Although there are numerous predisposing conditions, prosthetic valves (21%) the presence of a pacemaker (10%) and chronic IV access (9%) are increasingly implicated. 1 IE can be difficult to diagnose due to multiple (often non-specific) presenting features. The DUKE criteria 5 with subsequent modifications 6 have become established as a research tool for diagnosis of endocarditis ( Table 1) but their use as a clinical tool remains unclear. IE can be defined as community- acquired when diagnosed at time or within 48 hours of admission, health-care associated when it devel- ops in a patient who has been hospitalised for more than 48 hours prior to the onset of signs or symptoms, or non-nosocomial health-care-associated when it is diagnosed within 48 hours of admission in a patient with extensive health care contact. 1 The predominant causative organisms worldwide are now staphylococci ( Fig. 1), with Staphylococ- cus aureus accounting for 23% to 68% of all infec- tions, 1,2,7 although the aetiology of IE varies with clinical form with staphylococci ranging from 44% to 70% in nosocomial IE. 1,8 "Viridans group" strep- tococci are now the second most common pathogen accounting for 17% of all infections, 1 and 17% to 26% At least 2 positive cultures of blood samples drawn 112 h apart; or All of 3 or a majority of 4 separate cultures of blood (with first and last sample drawn at least 1 h apart) Single positive blood culture for Coxiella burnetii or antiphase I IgG antibody titer 11 : 800 evidence of endocardial involvement echocardiogram positive for Ie (Tee recommended in patients with prosthetic valves, rated at least "possible Ie" by clinical criteria, or complicated Ie [paravalvular abscess]; TTE as first test in other patients), defined as follows: ...