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Performance of the 2023 Duke-International Society of Cardiovascular Infectious Diseases Diagnostic Criteria for
Helena Lindberg1,2, Andreas Berge3,4, Martin Jovanovic-Stjernqvist2
1Department of Infectious Diseases, Hospital of Halland, Halmstad, Sweden.
Summary
The 2023 Duke-ISCVID criteria for infective endocarditis (IE) showed 80% sensitivity, reclassifying some possible IE cases to definite IE. Future criteria aim to reduce the possible IE category while maintaining sensitivity.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Revised diagnostic criteria for infective endocarditis (IE), the 2023 Duke-ISCVID criteria, require validation.
- Previous diagnostic standards, such as the 2000 modified Duke criteria, are compared against the new criteria.
Purpose of the Study:
- To validate the 2023 Duke-ISCVID criteria for infective endocarditis (IE).
- To compare the diagnostic classification and treatment implications of the modified Duke criteria versus the Duke-ISCVID criteria in patients with bacteremia.
Main Methods:
- Reanalysis of patient cohorts with various bacteremia types, including Staphylococcus aureus and HACEK.
- Classification of IE episodes as definite, possible, or rejected using both modified Duke and Duke-ISCVID criteria.
- Inclusion of advanced diagnostics like positron emission tomography-computed tomography and cardiac implanted electronic devices in reclassification.
Main Results:
- The modified Duke criteria classified 7.6% as definite IE, 29% as possible IE, and 63% as rejected IE in 4050 bacteremia episodes.
- The Duke-ISCVID criteria reclassified 0.3% from possible to definite IE and 12% from rejected to possible IE.
- Sensitivity of the Duke-ISCVID criteria, using treatment for IE as a reference, was 80%.
Conclusions:
- The Duke-ISCVID criteria reclassified a small number of episodes to definite IE, increasing the possible IE category.
- Future diagnostic criteria should aim to minimize the 'possible IE' classification while maintaining or improving sensitivity.
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