JCS 2026 Guideline on the Management of Infective Endocarditis

A Typical IE pathogens: Typical microorganisms causing IE include Staphylococcus aureus, Staphylococcus lugdunensis, Enterococcus faecalis, Granulicatella spp., Abiotrophia spp., Gemella spp., and HACEK group microorganisms.In cases of PVE, typical pathogens also include CoNS and Corynebacterium spp.B Definition of a "blood culture set": "Blood culture set" is defined as a simultaneously drawn pair of 1 aerobic and 1 anaerobic bottle."Positive" blood culture set is defined as microbial growth from at least 1 of the bottles.Blood cultures from separate venipuncture sites are strongly recommended whenever possible for evaluating suspected IE.No specific time interval for blood culture collection sets is stipulated.C Nucleic acid-based techniques: Nucleic acid-based techniques include PCR, in situ hybridization, amplicon sequencing, and shotgun metagenomic analysis.D Equivalent serological methods: other methods providing equivalent titers are also acceptable.E Vegetation: An infected mass of fibrin, platelets, and microorganisms attached to cardiac valves, prosthetic valves, or the endocardial surface.F Perforation: A localized tear of the valvular tissue caused by infection, potentially leading to acute regurgitation.G Aneurysm: A saccular outpouching of a valve leaflet due to infection, which carries a risk of acute valvular regurgitation associated with perforation.H Abscess: A localized collection of purulent material in the perivalvular or pericardiac soft tissues, most commonly around the aortic root or annulus.I Pseudoaneurysm: A pericardial or perivascular cavity communicating with the cardiovascular lumen caused by a partial disruption of the myocardium or endothelium.J Intracardiac fistula: An abnormal communication between 2 adjacent cardiac chambers through a perforation.K Abnormal FDG uptake on PET/CT: For PVE, intense, focal/multifocal, or heterogeneous FDG uptake is considered pathological; for native valve IE or CIED infection, any abnormal FDG uptake pattern is considered pathological.L Timing of PET/CT: PET/CT is recommended at least 3 months after prosthetic valve implantation, because abnormal uptake within 3 months of implantation may reflect postoperative inflammation.M Non-pathological (physiological) FDG uptake: Some prosthetic valves may show physiological, non-pathological FDG uptake.FDG uptake limited to the generator pocket site of a CIED, in the absence of endocardial infection, does not meet the major criteria.PET/CT is also useful for identifying extracardiac foci of infection.N Intraoperative diagnosis of IE: IE may be diagnosed intraoperatively when vegetation, perforation, abscess, or other definite lesions are observed directly.Appropriate specimens should still be submitted for histopathologic and microbiologic examination.O Prosthetic valves: Prosthetic valves includes valves implanted surgically or via transcatheter procedures.P Congenital heart disease: Congenital heart disease includes cyanotic CHD (tetralogy of Fallot, univentricular heart, complete transposition, truncus arteriosus, hypoplastic left heart), endocardial cushion defects, ventricular septal defect, left-sided lesions (bicuspid aortic valve, aortic stenosis and insufficiency, mitral valve prolapse, mitral stenosis and insufficiency), rightsided lesions (Ebstein anomaly, anomalies of the pulmonary valve, congenital tricuspid valve disease), patent ductus arteriosus, and other congenital anomalies, with or without repair.Q Immune complex-mediated glomerulonephritis: Defined, as either: (1) Unexplained presence of either acute kidney injury (AKI, defined later) or acute on chronic kidney injury (defined later) plus 2 of the following: hematuria, proteinuria, cellular casts on inspection of urinary sediment, or serologic perturbations (hypocomplementemia, cryoglobulinemia, and/or presence of circulating immune complexes); or (2) renal biopsy consistent with immune complex-mediated renal disease.AKI is defined as a new unexplained reduction in eGFR <60 mL/min/1.73m 2 .Acute on chronic kidney injury is defined as a reduction by at least 1 ordinal level in function (e.g., from "moderately decreased" to "severely decreased"; or from "severely decreased" to "kidney failure").Interpretive ranges for eGFR are as follows: normal 60 mL/min/1.73m 2 ; moderately decreased 30-59mL/min/1.73 m 2 ; severely decreased 15-29mL/min/1.73 m 2 ; and kidney failure <15 mL/min/1.73m 2 .R Exclusion of contaminants: Single positive blood culture or sequencing results for common skin commensals or microorganisms rarely causing IE should be excluded.S Physical examination criteria: Alternative findings may be considered in the absence of echocardiography, but changes in pre-existing cardiac murmurs alone do not meet the diagnostic criteria.