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Performance of Different Versions of Duke Criteria in Diagnosing Infective Endocarditis in Patients With Intracardiac

Matthaios Papadimitriou-Olivgeris1,2, Bruno Ledergerber3, Jana Epprecht3

  • 1Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

Open Forum Infectious Diseases
|September 5, 2025
PubMed

Insights

The 2023 ISCVID Duke criteria show higher sensitivity for diagnosing infective endocarditis (IE) in patients with prosthetic material than older ESC criteria. However, this improved detection comes with reduced specificity.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Clinical Diagnostics

Background:

  • Diagnosing infective endocarditis (IE) presents significant clinical challenges.
  • Intracardiac prosthetic material complicates IE diagnosis.
  • Evaluating updated clinical criteria is crucial for accurate IE detection.

Purpose of the Study:

  • Compare diagnostic performance of 2015 ESC, 2023 ESC, and 2023 ISCVID Duke criteria.
  • Assess criteria in patients with suspected IE and prosthetic material.
  • Determine the most sensitive and specific diagnostic approach.

Main Methods:

  • Retrospective study at two Swiss University Hospitals (2014-2024).
  • Reference standard: Endocarditis Team/expert clinician diagnosis.
  • Evaluated 1025 suspected IE episodes with intracardiac prosthetic material.

Main Results:

  • The 2023 ISCVID Duke criteria identified 42% of definite IE cases, higher than 2015 ESC (32%) and 2023 ESC (36%).
  • Sensitivity: 2023 ISCVID (71%) > 2023 ESC (61%) > 2015 ESC (56%).
  • Specificity: 2015 ESC (67%) > 2023 ESC (56%) > 2023 ISCVID (34%).

Conclusions:

  • The 2023 ISCVID Duke criteria offer superior sensitivity for IE diagnosis in prosthetic material patients.
  • This increased sensitivity is associated with a notable decrease in specificity.
  • Clinical application requires balancing sensitivity and specificity based on patient context.
Abstract

Keywords:
Duke criteriaEuropean society of cardiology (ESC)infective endocarditisinternational society for cardiovascular infectious diseases (ISCVID)prosthetic valve

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