Duke-ISCVID 2023 Criteria — JoyShine Medical

Applies the 2023 Duke-ISCVID criteria to classify suspected infective endocarditis as Definite, Possible, or Rejected by counting Major and Minor criteria; this is a criteria count, not a clinical rule-out.

Pathologic criteria (any one met = Definite IE)

Microorganisms identified in a vegetation, surgical specimen, or arterial embolus (with clinical signs of active endocarditis)

Active endocarditis identified histologically in cardiac tissue, prosthetic valve, aortic graft, CIED, or arterial embolus

Major - Microbiologic (any sub-item met = 1 Major)

Typical IE-causing organism from 2 or more separate blood culture sets

Occasional / rare IE organism from 3 or more separate blood culture sets

Positive PCR / nucleic acid test for Coxiella burnetii, Bartonella spp., or Tropheryma whipplei

Coxiella burnetii antiphase I IgG titer > 1:800 (or isolation from a single blood culture), or Bartonella henselae / quintana IgG titer ≥ 1:800 by indirect IFA

Major - Imaging (any sub-item met = 1 Major)

Echocardiography / cardiac CT showing vegetation, valve perforation, aneurysm, abscess, pseudoaneurysm, or intracardiac fistula

Significant new valvular regurgitation versus prior imaging

New partial prosthetic valve dehiscence versus prior imaging

[18F]FDG PET/CT abnormal metabolic activity on a native valve, or (≥ 3 months after implantation) on a prosthetic valve / ascending aortic graft (the graft with concomitant evidence of valve involvement) / CIED leads / other prosthetic material

Major - Surgical (any sub-item met = 1 Major)

IE documented by direct intraoperative inspection (gross findings of vegetation, perforation, abscess, etc.) when imaging criteria are not met and histologic / microbiologic confirmation is not yet available - the surgeon's visual identification of IE during surgery counts as a Major criterion in its own right

Minor - Predisposition (any sub-item met = 1 Minor)

Previous IE

Prosthetic valve

Previous valve repair

Congenital heart disease

More than mild regurgitation or stenosis of any etiology

Endovascular cardiac implantable electronic device (CIED)

Hypertrophic obstructive cardiomyopathy

Injection drug use

Minor - Other criteria (each counts as 1 Minor)

Fever > 38.0°C (100.4°F)

Vascular phenomena: arterial emboli, septic pulmonary infarcts, cerebral or splenic abscess, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, Janeway lesions, or purulent purpura

Immunologic phenomena: positive rheumatoid factor, Osler nodes, Roth spots, or immune complex glomerulonephritis

Microbiologic evidence (any one of the two items below together count as a single Minor) — positive blood culture for an IE-consistent organism not meeting a Major criterion threshold

Microbiologic evidence (counts with the item above as one Minor) — positive culture / PCR from a sterile body site (excluding cardiac tissue, prosthesis, embolus), or a single skin-bacterium PCR finding without supporting evidence

Imaging: [18F]FDG PET/CT abnormal metabolic activity within 3 months of prosthetic implantation