Ben-Ami et al proposed modifying the criteria for hospital-acquired infective endocarditis to include cases that occur within 6 months of a previous hospitalization during which an invasive procedure was performed. The authors are from Sackler School of Medicine at Tel Aviv University.
Criteria for hospital-acquired infective endocarditis - both of the following:
(1) onset of infective endocarditis >= 72 hours after hospitalization (not present on admission) up to 6 months after discharge from the hospital
(2) an invasive procedure was performed during the hospitalization
where:
• Previous criteria limited the window post-discharge to 4-8 weeks.
• In the implementation I included an additional criteria that no other cause was found after a careful evaluation.
The endocarditis may involve either native or prosthetic valves.
A significant invasive procedure is one that is associated with bacteremia or blood-stream infection. Such procedures include:
(1) dental procedures
(2) urogenital procedures (cystoscopy, bladder catheterization)
(3) gastrointestinal procedure (endoscopy, esophageal dilatation)
(4) cardiac surgery
(5) intravascular catheterization
(6) surgical incision through a mucus membrane
(7) surgical incision through infected skin
Pathogens suggestive of a hospital-acquired infection:
(1) methicillin resistant Staphylococcus aureus (MRSA)
(2) enteric gram negative bacteria (Enterobacteriaceae)
(3) coagulase negative Staphylococcus species
(4) others depending on the local isolation patterns within a hospital
