43
Figure 9. Diagnosis and Treatment of IE
Patient at Risk or With Suspected NVE or PVE
Blood cultures × 2
TTE/TEE
Modified Duke Criteria
Definite or
probable IE
Antibiotic Rx
(I)
Temporarily
discontinue
VKA
anticoagulation
(IIa)
Evaluate for need
and timing of
surgery
Pacer/ICD
present
Valve
dysfunction
causing HF
Resistant
organism
(S. aureus, fungi)
Heart block or
abscess
Persistent
infection
Relapsing PVE
Large mobile
vegetation
(native valve)
Recurrent
emboli and
persistent
vegetations
despite
appropriate
antibiotc Rx
Infection of
leads or device
pocket
NO YES
Remove
Hardware Early
(I)
Remove
Hardware
(IIa)
Early
Surgery
(IIb)
Surgery
(I)
Early
Surgery
a
(I)
a
Early surgery is defined as during initial hospitalization before completion of a full therapeutic
course of antibiotics.
Early
Surgery
(IIa)
Resistant
organism
(S. aureus,
fungi)
Valve
surgery
for IE
