2023 Duke-ISCVID criteria for infective endocarditis

Current versionInfectious disease·12 inputs·1 reference

Based on Fowler VG et al. (2023). Replaces Duke criteria for infective endocarditis (1994, with the 2000 "possible" definition), which is kept for comparison.

Decision support for clinicians — review before acting.

PATHOLOGIC: microorganisms or active endocarditis in a vegetation, cardiac tissue, explanted prosthesis or embolus MAJOR microbiologic: typical organism in ≥ 2 blood-culture sets (non-typical in ≥ 3); or Coxiella/Bartonella/T. whipplei by PCR or serology criteria MAJOR imaging: vegetation, perforation, aneurysm, abscess, pseudoaneurysm or fistula on echo/CT; new significant regurgitation; new prosthetic dehiscence; abnormal [18F]FDG PET/CT uptake at a prosthesis MAJOR surgical: endocarditis seen on direct intra-operative inspection (without other confirmation) Minor: predisposition — prior IE, prosthetic valve or repair, congenital heart disease, > mild regurgitation or stenosis, endovascular CIED, HCM, or injection drug use Minor: temperature > 38.0 °C Minor: vascular phenomena — arterial emboli, septic pulmonary infarcts, brain/spleen abscess, mycotic aneurysm, ICH, conjunctival hemorrhage, Janeway lesions, purulent purpura (including imaging-only findings) Minor: immunologic — positive rheumatoid factor, Osler nodes, Roth spots, immune-complex glomerulonephritis Minor: microbiologic evidence short of a major criterion Minor: abnormal PET/CT uptake within 3 months of prosthetic implantation Minor: new regurgitant murmur on auscultation when echocardiography is unavailable REJECT: firm alternative diagnosis; or no recurrence despite antibiotic therapy for < 4 days; or no pathologic or macroscopic evidence of IE at surgery or autopsy with antibiotic therapy for < 4 days

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References

Fowler VG, Durack DT, Selton-Suty C, et al. The 2023 Duke-International Society for Cardiovascular Infectious Diseases Criteria for Infective Endocarditis: Updating the Modified Duke Criteria. Clin Infect Dis. 2023;77:518-526. PMID: 37138445. doi: 10.1093/cid/ciad271 PubMed 37138445

Implementation notes

The rejection wording follows Table 1 of the 2023 Duke-ISCVID criteria (Fowler et al., Clin Infect Dis 2023), which changed the older "resolution with ≤ 4 days of antibiotics" to "lack of recurrence despite antibiotic therapy for less than 4 days". The paper calls itself a living document; no later revision was found.

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