Definitions of infective endocarditis according to the 2023 Duke-ISCVID IE Criteria: Table A

Definite endocarditis (must meet pathologic [either microbiologic or histopathologic criteria] or clinical criteria)

Pathologic criteria

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

Histopathologic findings of active endocarditis^¶ identified (may be acute^Δ or subacute/chronic^◊):
- In or on a vegetation
- From cardiac tissue
- From an explanted prosthetic valve or sewing ring
- From an ascending aortic graft (with concomitant evidence of valve involvement)
- From a CIED
- From an embolus

Clinical criteria (any of the following, outlined in Table B):

2 major criteria
1 major criterion and 3 minor criteria
5 minor criteria

Possible endocarditis

1 major criterion and 1 minor criteria
3 minor criteria

Rejected endocarditis

Firm alternate diagnosis explaining signs/symptoms^§
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 above criteria for possible IE

CIED: cardiac implantable electronic device; IE: infective endocarditis; PCR: polymerase chain reaction.

* Tools for microorganism identification include 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 [PAS-D], Grocott, or silver stains such as Warthin-Starry, Steiner, or Dieterle) should be interpreted cautiously, particularly in patients with a prior episode of IE; such tests can remain positive for extended periods following successful treatment. Antibiotic therapy prior to tissue procurement may alter microorganism morphology and staining characteristics. Test specificity is influenced by several factors, and false positives can occur. Test results should be interpreted 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.

¶ Active endocarditis refers to vegetations, leaflet destruction, or adjacent tissue (of native or prosthetic valves) demonstrating variable degrees of inflammatory cell infiltrates and healing. Many specimens demonstrate mixed features.

Δ Acute endocarditis refers to vegetations or cardiac/aortic tissue lesions (of native or prosthetic valves) demonstrating active inflammation without significant healing or organizational change.

◊ Subacute/chronic endocarditis refers to vegetations or cardiac/aortic tissue lesions (of native or prosthetic valves) demonstrating evidence of healing or attempted healing, and/or maturing granulation tissue and fibrosis showing variable mononuclear cell infiltration and/or calcification. Calcification can occur rapidly in injured tissue and vegetations, or it can be part of the underlying valvular disease that was the original nidus for IE.

§ Firm alternate diagnosis explaining signs and symptoms consists of either microbiologic or non-microbiologic causes. Firm alternate microbiologic diagnosis includes a) identifiable source for bloodstream infection with a nontypical IE pathogen; b) rapid resolution of bloodstream infection; and c) absence of evidence for IE on cardiac imaging. Firm alternate non-microbiologic diagnosis includes a) presence of non-IE cause for cardiac imaging findings (eg, marantic or nonbacterial thrombotic endocarditis) and b) absence of microbiologic evidence for IE.

Adapted from: Vance G Fowler, Jr, et al. 'The 2023 Duke-International Society for Cardiovascular Infectious Diseases Criteria for Infective Endocarditis: Updating the Modified Duke Criteria.' Clinical Infectious Diseases (77) 4 (2023): 518-526, https://doi.org/10.1093/cid/ciad271. Reproduced by permission of Oxford University Press on behalf of the Infectious Diseases Society of America. Adapted by permission of Dr. Vance Fowler, Jr.

Graphic 73023 Version 9.0

خرید پکیج

Definitions of infective endocarditis according to the 2023 Duke-ISCVID IE Criteria: Table A