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.