Table 3.
Updates to Modified Duke Criteria Proposed by 2023 Duke-International Society for Cardiovascular Infectious Diseases Infective Endocarditis (IE) Criteria
| CRITERIA | Change |
|---|---|
| PATHOLOGIC CRITERIA | |
| Microorganism identification | Microorganisms identified in appropriate sample by PCR, amplicon or metagenomic sequencing, or in situ hybridization |
| MAJOR CLINICAL CRITERIA | |
| Microbiology | |
| Blood cultures | Removed requirements for timing and separate venipunctures for blood cultures. |
| Definition of typical organisms | Added typical pathogens: 1) S. lugdunensis; E. faecalis; all streptococci except S. pneumoniae and S. pyogenes; Granulicatella spp.; Abiotrophia spp.; and Gemella spp. 2) Organisms to be considered “typical” IE pathogens in the setting of intracardiac prosthetic material: coagulase negative staphylococci, Corynebacterium striatum; C. jeikeium, Serratia marcescens, Pseudomonas aeruginosa, Cutibacterium acnes, nontuberculous mycobacteria, and Candida spp. |
| Other microbiologic tests | Added new Major Criteria for fastidious pathogens: 1) PCR or amplicon/metagenomic sequencing identifies C. burnetii, Bartonella spp., or T. whipplei from blood; or 2) IFA ≥1:800 for IgG antibodies identifies B. henselae or B. quintana. |
| Imaging | |
| Echocardiography | Similar to earlier versions. Cornerstone of imaging criterion. |
| Cardiac computed tomography | Added new Major Criterion. Findings equivalent to echocardiography. |
| [18F]FDG PET/CT | Added new Major Criterion. Findings for native valve, cardiac device, or prosthetic valve >3 mo after cardiac surgery are equivalent to echocardiography. |
| Surgical | Added new Major Criterion. Intraoperative inspection constitutes Major Criterion in absence of Major Criterion by cardiac imaging or histopathology. |
| MINOR CLINICAL CRITERIA | |
| Predisposition | Added transcatheter valve implant/repair, endovascular CIED, and prior diagnosis of IE. |
| Fever | Unchanged. |
| Vascular phenomena | Added splenic and cerebral abscess. |
| Immunologic phenomena | Added definition for immune complex mediated glomerulonephritis. |
| Microbiological | Added PCR or amplicon/metagenomic sequencing evidence of typical pathogen. |
| Imaging | Added PET/CT evidence <3 mo of cardiac surgery. |
| Physical examination | New auscultation of regurgitant murmur when echocardiography is unavailable. |
Abbreviations: [18F] FDG PET CT, positron emission computed tomography with 18F-fluorodeoxyglucose; CIED, cardiac implantable electronic device; IFA, immunofluorescence assay; PCR, polymerase chain reaction.