Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis
Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis
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DOI：
10.1086/313753
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发表时间：
2000-04-01
影响因子：
11.8
通讯作者：
Corey, GR
中科院分区：
文献类型：
--
作者：
Li, JS;Sexton, DJ;Corey, GR
尽管杜克标准诊断感染性心内膜炎（IE）的敏感性和特异性已被欧洲和美国的研究人员证实，但这种模式仍然存在一些缺点。杜克大学IE数据库包含了自1984年以来收集的约800例明确和可能的IE病例的前瞻性记录，杜克大学医学中心的超声心动图和金黄色葡萄球菌菌血症患者数据库也得到了维护。通过对这些数据库的分析、我们在临床实践中使用Duke标准的经验以及对其他人工作的分析，我们提出了以下对Duke模式的修改：“可能的IE”类别应定义为至少有1个主要标准和1个次要标准或3个次要标准。鉴于经食管超声心动图（TEE）的广泛应用，应取消“超声心动图符合IE但不符合主要标准”这一次要标准。金黄色葡萄球菌引起的菌血症应被视为主要标准，无论感染是否在医院获得或是否存在可清除的感染源。应将q热血清学阳性改为主要诊断标准。
Although the sensitivity and specificity of the Duke criteria for the diagnosis of infective endocarditis (IE) have been validated by investigators from Europe and the United States, several shortcomings of this schema remain. The Duke IE database contains records collected prospectively on >800 cases of definite and possible IE since 1984, Databases on echocardiograms and on patients with Staphylococcus aureus bacteremia at Duke University Medical Center are also maintained. Analyses of these databases, our experience with the Duke criteria in clinical practice, and analysis of the work of others have led us to propose the following modifications of the Duke schema, The category "possible IE" should be defined as having at least 1 major criterion and 1 minor criterion or 3 minor criteria. The minor criterion "echocardiogram consistent with IE but not meeting major criterion" should be eliminated, given the widespread use of transesophageal echocardiography (TEE). Bacteremia due to S. aureus should be considered a major criterion, regardless of whether the infection is nosocomially acquired or whether a removable source of infection is present. Positive Q-fever serology should be changed to a major criterion.