Endocarditis

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Infective Endocarditis: 2023 Duke‑ISCVID Quick Guide

The 2023 Duke-International Society for Cardiovascular Infectious Diseases Criteria for Infective Endocarditis: Updating the Modified Duke Criteria, Clinical Infectious Diseases, Volume 77, Issue 4, 15 August 2023, Pages 518–526, https://doi.org/10.1093/cid/ciad271

✨ Major Criteria

🧫 Microbiology

• Typical blood cultures: Staph. aureus, viridans streptococci, S. gallolyticus, Enterococcus faecalis, HACEK
• OR molecular tests (PCR/sequencing) from valve or sterile site
• OR positive serology: Coxiella, Bartonella

💓 Endocardial involvement

• Vegetation, abscess, or prosthetic valve dehiscence on echo, CT, PET/CT
• OR direct surgical / intra-operative visual evidence
• OR new valvular regurgitation

📝 Minor Criteria

• Predisposing heart condition, prosthetic valve, or IV drug use
• Fever ≥ 38°C
• Vascular signs: emboli, Janeway lesions, mycotic aneurysm
• Immunologic signs: glomerulonephritis, Osler nodes, Roth spots
• Microbiologic evidence not meeting major criteria

📌 Diagnosis

• Definite IE: 2 Major OR 1 Major + 3 Minor OR 5 Minor
• Possible IE: 1 Major + 1 Minor OR 3 Minor
• Rejected IE: Alternative diagnosis explains findings, or ≤4 days of antibiotics with resolution, or no pathological evidence

🆕 What’s New in 2023

• PET/CT & cardiac CT now count as major imaging criteria
• Molecular tests (PCR/sequencing) can confirm infection
• Prosthetic valve / device infections better recognised
• Visual confirmation in surgery counts
• Simplified blood culture rules

Symptoms and Signs

FROM JANE
Fever
Roth spots - Retinal haem with central clearing
Osler’s nodes - Tender nodules on tips of fingers or thenar eminence, sterile
Murmur
Janeway lesions - Painless, haemorrhagic, palms/soles, contain bacteria
Anaemia
Nail (splinter) haemorrhages (>4)
Emboli - CVA, retinal artery emboli, PE, MI, splenic infarct, Mycotic aneurysm - SAH
Also:
New onset CCF (70%)
Microscopic haematuria, proteinuria
Finger clubbing
Hepatomegaly, splenomegaly