The 2023 Duke-International Society for Cardiovascular Infectious Diseases Criteria for Infective Endocarditis: Updating the Modified Duke Criteria

TLDR

The microbiology, epidemiology, diagnostics, and treatment of infective endocarditis have evolved markedly since the original Duke Criteria were published in 1994 and revised in 2000. The International Society for Cardiovascular Infectious Diseases convened a multidisciplinary Working Group to update the diagnostic criteria for IE. The 2023 Duke‑ISCVID criteria introduce new microbiology tests (enzyme immunoassay for Bartonella, PCR, metagenomic sequencing, in‑situ hybridization), advanced imaging (18F‑FDG PET/CT, cardiac CT), and intraoperative inspection as a new major criterion; they expand the list of typical organisms to include prosthesis‑associated pathogens, eliminate separate venipuncture timing requirements, and clarify additional predisposing conditions. These diagnostic criteria should be updated periodically by making the Duke‑ISCVID Criteria available online as a “Living Document.”.

Abstract

The microbiology, epidemiology, diagnostics, and treatment of infective endocarditis (IE) have changed significantly since the Duke Criteria were published in 1994 and modified in 2000. The International Society for Cardiovascular Infectious Diseases (ISCVID) convened a multidisciplinary Working Group to update the diagnostic criteria for IE. The resulting 2023 Duke-ISCVID IE Criteria propose significant changes, including new microbiology diagnostics (enzyme immunoassay for Bartonella species, polymerase chain reaction, amplicon/metagenomic sequencing, in situ hybridization), imaging (positron emission computed tomography with 18F-fluorodeoxyglucose, cardiac computed tomography), and inclusion of intraoperative inspection as a new Major Clinical Criterion. The list of "typical"microorganisms causing IE was expanded and includes pathogens to be considered as typical only in the presence of intracardiac prostheses. The requirements for timing and separate venipunctures for blood cultures were removed. Last, additional predisposing conditions (transcatheter valve implants, endovascular cardiac implantable electronic devices, prior IE) were clarified. These diagnostic criteria should be updated periodically by making the Duke-ISCVID Criteria available online as a "Living Document."