Performance of the 2023 Duke-ISCVID diagnostic criteria for infective endocarditis in relation to the modified Duke criteria and to clinical management- reanalysis of retrospective bacteremia cohorts

BackgroundRevised diagnostic criteria for infective endocarditis (IE), the 2023 Duke-ISCVID criteria, were recently presented and need validation. Here, we compare the 2000 modified Duke criteria for IE with Duke-ISCVID among patients with bacteremia and relate the diagnostic classification to IE-treatment.MethodsWe reanalyzed patient cohorts with Stapylococcus aureus, Staphylococcus lugdunensis, non-beta-hemolytic streptococci, Streptococcus-like bacteria, Streptococcus dysgalactiae, Enterococcus faecalis and HACEK bacteremia. Episodes were classified as definite, possible or rejected IE with the modified Duke and Duke-ISCVID criteria. Reclassification included the microbiology criteria, PET-CT and cardiac implanted elect-ronical devices. To calculate sensitivity, patients treated as IE were considered as having IE.ResultsIn 4050 episodes of bacteremia, the modified Duke criteria criteria assigned 307episodes (7.6%) as definite IE, 1190 episodes (29%) as possible IE and 2553 episodes (63%) as rejected IE. Using the Duke-ISCVID criteria, 13 episodes (0.3%) were reclassified from possible to definite IE and 475 episodes (12%) were reclassified from rejected to possible IE. With the modified Duke criteria, 79 episodes that were treated as IE were classified as possible IE and eleven of these episodes were reclassified to definite IE with Duke-ISCVID. Applying the decision to treat for IE as reference standard, the sensitivity of the Duke-ISCVID criteria was 80%. None of the 475 episodes reclassified to possible IE were treated as IE.ConclusionsThe Duke-ISCVID criteria reclassified a small proportion of episodes to definite IE at the expense of more episodes of possible IE. Future criteria should minimize the possible group while keeping or improving sensitivity.