Hyperqbank

_id

683a165dc782e11e38d1b397

id

10564

title

2023 Duke-International Society for Cardiovascular Infectious Diseases (ISCVID) Criteria

full_title

2023 Duke-International Society for Cardiovascular Infectious Diseases (ISCVID) Criteria

short_title

2023 Duke-ISCVID Criteria

med_description

Diagnostic criteria for infective endocarditis.

short_description

IE diagnostic criteria.

slug

2023-duke-international-society-cardiovascular-infectious-diseases-iscvid-criteria

description

The 2023 Duke-International Society for Cardiovascular Infectious Diseases (ISCVID) Criteria diagnoses infective endocarditis.

keywords

Duke-International Society for Cardiovascular Infectious Diseases (ISCVID) Criteria, Duke-ISCVID Criteria, Duke criteria, ISCVID, infective endocarditis, IE, endocarditis, echocardiography, 2023 Duke-ISCVID IE Criteria, IE Pathologic Criteria, Blood culture negative endocarditis, BCNE

complaint

[ "Cough", "Extremity Edema", "Fatigue", "Fever", "Joint Pain", "Myalgias", "Palpitations", "Peripheral Edema", "Shortness of Breath", "Weight Loss/Gain" ]

formula

evidence

measurements

[]

information

The diagnosis of infective endocarditis (IE) is defined as follows:

I. Definite Endocarditis

Pathologic Criteria:

Microorganisms identified^t in the context of clinical signs of active endocarditis in a vegetation
(From cardiac tissue, an explanted prosthetic valve or sewing ring, an ascending aortic graft (with concomitant evidence of valve involvement), an endovascular CIED, or an arterial embolus)
or

Active endocarditis^u (may be acute^w or subacute/chronic^x) identified in or on a vegetation
(From cardiac tissue, an explanted prosthetic valve or sewing ring, an ascending aortic graft (with concomitant evidence of valve involvement), a CIED, or an arterial embolus)

Clinical Criteria:

2 major criteria

1 major criterion and 3 minor criteria

5 minor criteria

II. Possible Endocarditis

1 major criterion and 1 minor criterion

3 minor criteria

III. Rejected Endocarditis

Firm alternate diagnosis explaining signs/symptoms^y

Lack of recurrence despite antibiotic therapy for less than 4 days

No pathologic or macroscopic evidence of IE at surgery or autopsy, with antibiotic therapy for less than 4 days

Does not meet criteria for possible IE, as above

^tBy culture, staining, immunologic techniques, PCR, or other nucleic acid-based tests including amplicon (16S, 18S, internal transcribed spacers) sequencing, metagenomic (shotgun) sequencing, or in situ hybridization on fresh or paraffin-fixed tissue. Molecular techniques and tissue staining (Gram stain, periodic acid-Schiff with diastase, Grocott, or silver stains such as Warthin-Starry, Steiner, or Dieterle) should be interpreted cautiously, particularly in patients with a prior episode of IE, because such tests can remain positive for extended periods following successful treatment. Antibiotic therapy before tissue procurement may also significantly alter microorganism morphology and staining characteristics. Test specificity is influenced by several factors, and false positives can occur. Test interpretation should always be in the context of clinical and histological evidence of active endocarditis. A single finding of a skin bacterium by PCR on a valve or wire without additional clinical or microbiological supporting evidence should be regarded as a minor criterion and not definite IE.

^uActive endocarditis—Vegetations, leaflet destruction, or adjacent tissue of native or prosthetic valves showing variable degrees of inflammatory cell infiltrates and healing. Many specimens demonstrate mixed features.

^wAcute endocarditis—Vegetations or cardiac/aortic tissue lesions of native or prosthetic valves showing active inflammation without significant healing or organizational change.

^xSubacute/chronic endocarditis—Vegetations or cardiac/aortic tissue lesions of native or prosthetic valves demonstrating evidence of healing or attempted healing: maturing granulation tissue and fibrosis showing variable mononuclear cell infiltration and/or calcification. Calcification can occur rapidly in injured tissue and vegetations or be part of the underlying valvular disease that was the original nidus for IE.

^yA firm alternate diagnosis explaining IE signs and symptoms consists of either microbiologic or nonmicrobiologic causes. Firm alternate microbiologic diagnosis includes (1) identifiable source for bloodstream infection with a nontypical IE pathogen, (2) rapid resolution of bloodstream infection, and (3) absence of evidence for IE on cardiac imaging. Firm alternate nonmicrobiologic diagnosis includes (1) presence of non-IE cause for cardiac imaging findings (e.g., marantic or nonbacterial thrombotic endocarditis) and (2) absence of microbiologic evidence for IE.

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://pubmed.ncbi.nlm.nih.gov/37138445/", "text": "Fowler VG, Durack DT, Selton-Suty C, et al. The 2023 duke-international society for cardiovascular infectious diseases criteria for infective endocarditis: updating the modified duke criteria. Clinical Infectious Diseases. 2023;77(4):518-526." } ], "Other References": [], "Outcomes": [], "Validation": [ { "href": "https://academic.oup.com/cid/article-abstract/78/4/937/7603542?redirectedFrom=fulltext", "text": "Goehringer F, Lalloué B, Selton-Suty C, et al. Compared performance of the 2023 duke–international society for cardiovascular infectious diseases, 2000 modified duke, and 2015 european society of cardiology criteria for the diagnosis of infective endocarditis in a french multicenter prospective cohort. Clinical Infectious Diseases. 2024;78(4):937-948." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/38330172", "text": "Moisset H, Rio J, Benhard J, et al. Evaluation of the specificity of the 2023 duke-international society of cardiovascular infectious diseases classification for infective endocarditis. Clinical Infectious Diseases. 2024;78(4):930-936." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/38330243", "text": "Papadimitriou-Olivgeris M, Monney P, Frank M, et al. Evaluation of the 2023 duke-international society of cardiovascular infectious diseases criteria in a multicenter cohort of patients with suspected infective endocarditis. Clinical Infectious Diseases. 2024;78(4):949-955." }, { "href": "https://pubmed.ncbi.nlm.nih.gov/38330166/", "text": "van der Vaart TW, Bossuyt PMM, Durack DT, et al. External validation of the 2023 duke–international society for cardiovascular infectious diseases diagnostic criteria for infective endocarditis. Clinical Infectious Diseases. 2024;78(4):922-929." } ], "Validations": [] }

pearls

An update to the 2000 modified Duke criteria, aiming to improve the diagnosis of IE by incorporating contemporary clinical insights and newer diagnostic techniques.
Has a higher sensitivity and similar specificity compared to the modified Duke criteria.
This tool does not explicitly include the criteria to rule out the diagnosis of IE. Please see the Evidence tab for additional information.

usecase

Use in patients with suspected infective endocarditis (IE).

reasons

These criteria encompass clinical, microbiological, imaging, and surgical findings, providing a multifaceted approach to diagnosis. Prompt diagnosis of IE is essential to reduce delays in treatment and minimize the risk of complications.

next_advice

These criteria should be used in conjunction with clinical judgment to guide the diagnosis of infective endocarditis.
Based on the results, the following steps may be appropriate. Be sure to refer to clinical guidelines and exercise appropriate judgment within the specific clinical context:
- Definite IE: Start appropriate antibiotic therapy tailored to culture results and antibiotic susceptibility data. Identify patients who may need surgical treatment and consult specialists, as appropriate.
- Possible IE: Use clinical judgment. Consider additional testing, repeat blood cultures, and clinical monitoring for new or developing signs and symptoms. Empirical antibiotic therapy can be started if suspicion remains high.
- Does not meet criteria or rejected IE (please see "Facts & Figures" in the Evidence tab for the possible means by which the diagnosis of IE may be rejected): Evaluate for other potential diagnoses that may explain the patient’s signs and symptoms. If empirical antibiotic therapy was started, consider its discontinuation.

next_actions

next_management

diseases

[ "Bacterial Infections", "Endocarditis" ]

input_schema

{ "inct": null, "option_fhir_rules": null, "subheading": "Major Criteria:", "subheading_instructions": null, "type": "subheading" }

{ "inct": null, "option_fhir_rules": null, "subheading": "A. Microbiologic Major Criteria", "subheading_instructions": null, "type": "subheading" }

{ "conditionality": null, "default": null, "label_en": "Microorganisms that commonly cause IE isolated from 2 or more separate blood culture sets (typical)", "md_calc_info_concept": null, "name": "q1", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }

{ "conditionality": null, "default": null, "label_en": "Microorganisms that occasionally or rarely cause IE isolated from 3 or more separate blood culture sets (nontypical)", "md_calc_info_concept": null, "name": "q2", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }

{ "conditionality": null, "default": null, "label_en": "Positive PCR or other nucleic acid-based technique for Coxiella burnetii, Bartonella species, or Tropheryma whipplei from blood", "md_calc_info_concept": null, "name": "q3", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }

{ "conditionality": null, "default": null, "label_en": "Coxiella burnetii antiphase I IgG antibody titer >1:800, or isolated from a single blood culture", "md_calc_info_concept": null, "name": "q4", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }

{ "conditionality": null, "default": null, "label_en": "Indirect <abbr title=\"Immunofluorescence assays\">IFA</abbr> for detection of IgM and IgG antibodies to Bartonella henselae or Bartonella quintana with IgG titer ≥1:800", "md_calc_info_concept": null, "name": "q5", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }

{ "inct": null, "option_fhir_rules": null, "subheading": "B. Imaging Major Criteria", "subheading_instructions": null, "type": "subheading" }

{ "conditionality": null, "default": null, "label_en": "Echocardiography and/or cardiac CT showing vegetation, valvular/leaflet perforation, valvular/leaflet aneurysm, abscess, pseudoaneurysm, or intracardiac fistula", "md_calc_info_concept": null, "name": "q6", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }

{ "conditionality": null, "default": null, "label_en": "Significant new valvular regurgitation on echocardiography as compared with previous imaging. Worsening or changing of preexisting regurgitation is not sufficient.", "md_calc_info_concept": null, "name": "q7", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }

{ "conditionality": null, "default": null, "label_en": "New partial dehiscence of prosthetic valve as compared with previous imaging", "md_calc_info_concept": null, "name": "q8", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }

{ "conditionality": null, "default": null, "label_en": "<abbr title=\"Positron emission computed tomography with 18F-fluorodeoxyglucose\">[18F]FDG PET/CT</abbr> imaging: abnormal metabolic activity involving a native or prosthetic valve, ascending aortic graft (with concomitant evidence of valve involvement), intracardiac device leads, or other prosthetic material", "md_calc_info_concept": null, "name": "q9", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }

{ "inct": null, "option_fhir_rules": null, "subheading": "C. Surgical Major Criteria", "subheading_instructions": null, "type": "subheading" }

{ "conditionality": null, "default": null, "label_en": "Evidence of IE documented by direct inspection during heart surgery without meeting major imaging criteria or subsequent histologic or microbiologic confirmation", "md_calc_info_concept": null, "name": "q10", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }

{ "inct": null, "option_fhir_rules": null, "subheading": "Minor Criteria:", "subheading_instructions": null, "type": "subheading" }

{ "conditionality": null, "default": null, "label_en": "Previous history of IE", "md_calc_info_concept": null, "name": "q11", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }

{ "conditionality": null, "default": null, "label_en": "Prosthetic valve", "md_calc_info_concept": null, "name": "q12", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }

{ "conditionality": null, "default": null, "label_en": "Previous valve repair", "md_calc_info_concept": null, "name": "q13", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }

{ "conditionality": null, "default": null, "label_en": "Congenital heart disease", "md_calc_info_concept": null, "name": "q14", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }

{ "conditionality": null, "default": null, "label_en": "More than mild regurgitation or stenosis of any etiology", "md_calc_info_concept": null, "name": "q15", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }

{ "conditionality": null, "default": null, "label_en": "Endovascular <abbr title=\"Intracardiac implantable electronic device\">CIED</abbr>", "md_calc_info_concept": null, "name": "q16", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }

{ "conditionality": null, "default": null, "label_en": "Hypertrophic obstructive cardiomyopathy", "md_calc_info_concept": null, "name": "q17", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }

{ "conditionality": null, "default": null, "label_en": "Injection drug use", "md_calc_info_concept": null, "name": "q18", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }

{ "conditionality": null, "default": null, "label_en": "Fever with a documented temperature >38.0°C (100.4°F)", "md_calc_info_concept": null, "name": "q19", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }

{ "conditionality": null, "default": null, "label_en": "Vascular phenomena, including clinical or radiological evidence of arterial emboli, septic pulmonary infarcts, cerebral or splenic abscess, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, Janeway lesions, or purulent purpura", "md_calc_info_concept": null, "name": "q20", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }

{ "conditionality": null, "default": null, "label_en": "Immunologic phenomena, including positive rheumatoid factor, Osler nodes, Roth spots, or immune complex-mediated glomerulonephritis", "md_calc_info_concept": null, "name": "q21", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }

{ "conditionality": null, "default": null, "label_en": "Positive blood cultures for a microorganism consistent with IE but not meeting the requirements for major criterion", "md_calc_info_concept": null, "name": "q22", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }

{ "conditionality": null, "default": null, "label_en": "Positive culture, PCR, or other nucleic acid-based test (amplicon or shotgun sequencing, in situ hybridization) for an organism consistent with IE from a sterile body site other than cardiac tissue, cardiac prosthesis, or arterial embolus; or a single finding of a skin bacterium by PCR on a valve or wire without additional clinical or microbiological supporting evidence", "md_calc_info_concept": null, "name": "q23", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }

{ "conditionality": null, "default": null, "label_en": "Abnormal metabolic activity as detected by [18F]FDG PET/CT within 3 months of implantation of prosthetic valve, ascending aortic graft (with concomitant evidence of valve involvement), intracardiac device leads, or other prosthetic material", "md_calc_info_concept": null, "name": "q24", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }

{ "conditionality": null, "default": null, "label_en": "New valvular regurgitation identified on auscultation, if echocardiography is not available. Worsening or changing of a preexisting murmur is not sufficient.", "md_calc_info_concept": null, "name": "q25", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }

{ "inct": null, "option_fhir_rules": null, "subheading": "Pathologic Criteria:", "subheading_instructions": null, "type": "subheading" }

{ "conditionality": null, "default": 0, "label_en": "Microorganisms identified in the context of clinical signs of active endocarditis in a vegetation\n(From cardiac tissue, an explanted prosthetic valve or sewing ring, an ascending aortic graft (with concomitant evidence of valve involvement), an endovascular CIED, or an arterial embolus)\n", "md_calc_info_concept": null, "name": "p1", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }

{ "conditionality": null, "default": 0, "label_en": "Active endocarditis (may be acute or subacute/chronic) identified in or on a vegetation\n(From cardiac tissue, an explanted prosthetic valve or sewing ring, an ascending aortic graft (with concomitant evidence of valve involvement), a CIED, or an arterial embolus)\n", "md_calc_info_concept": null, "name": "p2", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }

[ { "inct": null, "option_fhir_rules": null, "subheading": "Major Criteria:", "subheading_instructions": null, "type": "subheading" }, { "inct": null, "option_fhir_rules": null, "subheading": "A. 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Worsening or changing of preexisting regurgitation is not sufficient.", "md_calc_info_concept": null, "name": "q7", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }, { "conditionality": null, "default": null, "label_en": "New partial dehiscence of prosthetic valve as compared with previous imaging", "md_calc_info_concept": null, "name": "q8", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }, { "conditionality": null, "default": null, "label_en": "<abbr title=\"Positron emission computed tomography with 18F-fluorodeoxyglucose\">[18F]FDG PET/CT</abbr> imaging: abnormal metabolic activity involving a native or prosthetic valve, ascending aortic graft (with concomitant evidence of valve involvement), intracardiac device leads, or other prosthetic material", "md_calc_info_concept": null, "name": "q9", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }, { "inct": null, "option_fhir_rules": null, "subheading": "C. Surgical Major Criteria", "subheading_instructions": null, "type": "subheading" }, { "conditionality": null, "default": null, "label_en": "Evidence of IE documented by direct inspection during heart surgery without meeting major imaging criteria or subsequent histologic or microbiologic confirmation", "md_calc_info_concept": null, "name": "q10", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }, { "inct": null, "option_fhir_rules": null, "subheading": "Minor Criteria:", "subheading_instructions": null, "type": "subheading" }, { "conditionality": null, "default": null, "label_en": "Previous history of IE", "md_calc_info_concept": null, "name": "q11", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }, { "conditionality": null, "default": null, "label_en": "Prosthetic valve", "md_calc_info_concept": null, "name": "q12", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }, { "conditionality": null, "default": null, "label_en": "Previous valve repair", "md_calc_info_concept": null, "name": "q13", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }, { "conditionality": null, "default": null, "label_en": "Congenital heart disease", "md_calc_info_concept": null, "name": "q14", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }, { "conditionality": null, "default": null, "label_en": "More than mild regurgitation or stenosis of any etiology", "md_calc_info_concept": null, "name": "q15", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }, { "conditionality": null, "default": null, "label_en": "Endovascular <abbr title=\"Intracardiac implantable electronic device\">CIED</abbr>", "md_calc_info_concept": null, "name": "q16", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }, { "conditionality": null, "default": null, "label_en": "Hypertrophic obstructive cardiomyopathy", "md_calc_info_concept": null, "name": "q17", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }, { "conditionality": null, "default": null, "label_en": "Injection drug use", "md_calc_info_concept": null, "name": "q18", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }, { "conditionality": null, "default": null, "label_en": "Fever with a documented temperature >38.0°C (100.4°F)", "md_calc_info_concept": null, "name": "q19", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }, { "conditionality": null, "default": null, "label_en": "Vascular phenomena, including clinical or radiological evidence of arterial emboli, septic pulmonary infarcts, cerebral or splenic abscess, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, Janeway lesions, or purulent purpura", "md_calc_info_concept": null, "name": "q20", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }, { "conditionality": null, "default": null, "label_en": "Immunologic phenomena, including positive rheumatoid factor, Osler nodes, Roth spots, or immune complex-mediated glomerulonephritis", "md_calc_info_concept": null, "name": "q21", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }, { "conditionality": null, "default": null, "label_en": "Positive blood cultures for a microorganism consistent with IE but not meeting the requirements for major criterion", "md_calc_info_concept": null, "name": "q22", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }, { "conditionality": null, "default": null, "label_en": "Positive culture, PCR, or other nucleic acid-based test (amplicon or shotgun sequencing, in situ hybridization) for an organism consistent with IE from a sterile body site other than cardiac tissue, cardiac prosthesis, or arterial embolus; or a single finding of a skin bacterium by PCR on a valve or wire without additional clinical or microbiological supporting evidence", "md_calc_info_concept": null, "name": "q23", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }, { "conditionality": null, "default": null, "label_en": "Abnormal metabolic activity as detected by [18F]FDG PET/CT within 3 months of implantation of prosthetic valve, ascending aortic graft (with concomitant evidence of valve involvement), intracardiac device leads, or other prosthetic material", "md_calc_info_concept": null, "name": "q24", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }, { "conditionality": null, "default": null, "label_en": "New valvular regurgitation identified on auscultation, if echocardiography is not available. Worsening or changing of a preexisting murmur is not sufficient.", "md_calc_info_concept": null, "name": "q25", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }, { "inct": null, "option_fhir_rules": null, "subheading": "Pathologic Criteria:", "subheading_instructions": null, "type": "subheading" }, { "conditionality": null, "default": 0, "label_en": "Microorganisms identified in the context of clinical signs of active endocarditis in a vegetation\n(From cardiac tissue, an explanted prosthetic valve or sewing ring, an ascending aortic graft (with concomitant evidence of valve involvement), an endovascular CIED, or an arterial embolus)\n", "md_calc_info_concept": null, "name": "p1", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" }, { "conditionality": null, "default": 0, "label_en": "Active endocarditis (may be acute or subacute/chronic) identified in or on a vegetation\n(From cardiac tissue, an explanted prosthetic valve or sewing ring, an ascending aortic graft (with concomitant evidence of valve involvement), a CIED, or an arterial embolus)\n", "md_calc_info_concept": null, "name": "p2", "option_fhir_rules": null, "optional": true, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "See <a href='#evidence'>Evidence</a> for more details.", "type": "toggle" } ]

instructions

published

2024-08-28T18:25:43.914Z

purpose

[ "Diagnosis" ]

search_terms

[ "Duke-International Society for Cardiovascular Infectious Diseases (ISCVID) Criteria", "Duke-ISCVID Criteria", "Duke criteria", "ISCVID", "infective endocarditis", "IE", "endocarditis", "echocardiography", "2023 Duke-ISCVID IE Criteria", "IE Pathologic Criteria", "Blood culture negative endocarditis", "BCNE" ]

seo

{ "keywords_en": "Duke-International Society for Cardiovascular Infectious Diseases (ISCVID) Criteria, Duke-ISCVID Criteria, Duke criteria, ISCVID, infective endocarditis, IE, endocarditis, echocardiography, 2023 Duke-ISCVID IE Criteria, IE Pathologic Criteria, Blood culture negative endocarditis, BCNE", "meta_description_en": "The 2023 Duke-International Society for Cardiovascular Infectious Diseases (ISCVID) Criteria diagnoses infective endocarditis." }

specialty

[ "Cardiology", "Critical Care", "Emergency Medicine", "Family Practice", "Hospitalist Medicine", "Infectious Disease", "Internal Medicine", "Primary Care", "Surgery (Cardiothoracic)" ]

departments

[ "Cardiac", "Infectious" ]

version_number

versions

[]

[ { "calcId": 10470, "short_title_en": "VIRSTA Score", "slug": "virsta-score" }, { "calcId": 4027, "short_title_en": "Jones Criteria for ARF", "slug": "jones-criteria-acute-rheumatic-fever-diagnosis" }, { "calcId": 3121, "short_title_en": "IE Mortality Risk Score", "slug": "infective-endocarditis-ie-mortality-risk-score" } ]

ismed

false

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "cardiology", "infectious" ]

cleaned_use

[ "Use in patients with suspected infective endocarditis (IE)." ]

pub

false

Major Criteria:

A. Microbiologic Major Criteria

Microorganisms that commonly cause IE isolated from 2 or more separate blood culture sets (typical)

Microorganisms that occasionally or rarely cause IE isolated from 3 or more separate blood culture sets (nontypical)

Positive PCR or other nucleic acid-based technique for Coxiella burnetii, Bartonella species, or Tropheryma whipplei from blood

Coxiella burnetii antiphase I IgG antibody titer >1:800, or isolated from a single blood culture

Indirect <abbr title="Immunofluorescence assays">IFA</abbr> for detection of IgM and IgG antibodies to Bartonella henselae or Bartonella quintana with IgG titer ≥1:800

B. Imaging Major Criteria

Echocardiography and/or cardiac CT showing vegetation, valvular/leaflet perforation, valvular/leaflet aneurysm, abscess, pseudoaneurysm, or intracardiac fistula

Significant new valvular regurgitation on echocardiography as compared with previous imaging. Worsening or changing of preexisting regurgitation is not sufficient.

New partial dehiscence of prosthetic valve as compared with previous imaging

<abbr title="Positron emission computed tomography with 18F-fluorodeoxyglucose">[18F]FDG PET/CT</abbr> imaging: abnormal metabolic activity involving a native or prosthetic valve, ascending aortic graft (with concomitant evidence of valve involvement), intracardiac device leads, or other prosthetic material

C. Surgical Major Criteria

Evidence of IE documented by direct inspection during heart surgery without meeting major imaging criteria or subsequent histologic or microbiologic confirmation

Minor Criteria:

Previous history of IE

Prosthetic valve

Previous valve repair

Congenital heart disease

More than mild regurgitation or stenosis of any etiology

Endovascular <abbr title="Intracardiac implantable electronic device">CIED</abbr>

Hypertrophic obstructive cardiomyopathy

Injection drug use

Fever with a documented temperature >38.0°C (100.4°F)

Vascular phenomena, including clinical or radiological evidence of arterial emboli, septic pulmonary infarcts, cerebral or splenic abscess, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, Janeway lesions, or purulent purpura

Immunologic phenomena, including positive rheumatoid factor, Osler nodes, Roth spots, or immune complex-mediated glomerulonephritis

Positive blood cultures for a microorganism consistent with IE but not meeting the requirements for major criterion

Positive culture, PCR, or other nucleic acid-based test (amplicon or shotgun sequencing, in situ hybridization) for an organism consistent with IE from a sterile body site other than cardiac tissue, cardiac prosthesis, or arterial embolus; or a single finding of a skin bacterium by PCR on a valve or wire without additional clinical or microbiological supporting evidence

Abnormal metabolic activity as detected by [18F]FDG PET/CT within 3 months of implantation of prosthetic valve, ascending aortic graft (with concomitant evidence of valve involvement), intracardiac device leads, or other prosthetic material

New valvular regurgitation identified on auscultation, if echocardiography is not available. Worsening or changing of a preexisting murmur is not sufficient.

Pathologic Criteria:

Microorganisms identified in the context of clinical signs of active endocarditis in a vegetation (From cardiac tissue, an explanted prosthetic valve or sewing ring, an ascending aortic graft (with concomitant evidence of valve involvement), an endovascular CIED, or an arterial embolus)

Active endocarditis (may be acute or subacute/chronic) identified in or on a vegetation (From cardiac tissue, an explanted prosthetic valve or sewing ring, an ascending aortic graft (with concomitant evidence of valve involvement), a CIED, or an arterial embolus)

_id

id