To the Editor—We appreciate the interest expressed by the multiple letter writers and respond to the points raised regarding our article [1]:
Yamamoto pointed out that external validation of the 2023 Duke–International Society for Cardiovascular Infectious Diseases (ISCVID) criteria are essential.
Lindberg and colleagues make an interesting suggestion that the 2023 Duke-ISCVID criteria could be revised so that “patients fulfilling major imaging criteria and having significant bacteremia, irrespective of species, should be regarded as definite IE [infective endocarditis]” and use the example of Enterococcus faecium to underscore their point.
Xie and Tong correctly point out the need for “caution in the interpretation of the new list of ‘typical’ organisms” and provide a helpful figure to illustrate their point regarding the risk of Streptococcus dysgalactiae subspecies equisimilis.
Sunnerhagen and colleagues suggest that suggest that Aerococcus urinae, while rare, should be regarded as “typical” bacteria and provide a table of compelling evidence to support their argument.
Regarding point 1, we agree with Yamamoto. Studies from several countries are currently in peer review to externally evaluate the performance of the 2023 Duke-ISCVID criteria.
Regarding points 2–4, the valid points raised by Lindberg et al, Xie and Tong, and Sunnerhagen et al underscore the importance of a key characteristic of the Duke-ISCVID criteria: the “living document” format. Our vision is that such a format will allow for periodic reassessment of specific aspects of the diagnostic criteria as new or better data become available. Thus, the points raised by these authors will be specifically considered in the next iteration of the Duke-ISCVID criteria.
Contributor Information
Vance G Fowler, Jr, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
Jose M Miro, Infectious Diseases Service, Hospital Clinic–Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.
Notes
Financial support. This work was supported by grant 1R01-AI165671 (to V. G. F.) from the National Institutes of Health (NIH). J. M. M. received a personal 80:20 research grant from Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, during 2017–2023.
Reference
- 1. 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; 77:518–26. [DOI] [PMC free article] [PubMed] [Google Scholar]