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Performance of the 2023 Duke-ISCVID diagnostic criteria for infective endocarditis in relation to the modified Duke criteria and to clinical management- reanalysis of retrospective bacteremia cohorts

Lindberg, Helena LU ; Berge, Andreas ; Jovanovic-Stjernqvist, Martin ; Hagstrand Aldman, Malin LU orcid ; Krus, David ; Öberg, Jonas LU orcid ; Kahn, Fredrik LU ; Bläckberg, Anna LU ; Sunnerhagen, Torgny LU orcid and Rasmussen, Magnus LU (2024) In Clinical Infectious Diseases 78(4). p.956-963
Abstract
Background
Revised diagnostic criteria for infective endocarditis (IE), the 2023 Duke-ISCVID criteria, were recently presented and need validation. Here, we compare the 2000 modified Duke criteria for IE with Duke-ISCVID among patients with bacteremia and relate the diagnostic classification to IE-treatment.

Methods
We reanalyzed patient cohorts with Stapylococcus aureus, Staphylococcus lugdunensis, non-beta-hemolytic streptococci, Streptococcus-like bacteria, Streptococcus dysgalactiae, Enterococcus faecalis and HACEK bacteremia. Episodes were classified as definite, possible or rejected IE with the modified Duke and Duke-ISCVID criteria. Reclassification included the microbiology criteria, PET-CT and cardiac implanted... (More)
Background
Revised diagnostic criteria for infective endocarditis (IE), the 2023 Duke-ISCVID criteria, were recently presented and need validation. Here, we compare the 2000 modified Duke criteria for IE with Duke-ISCVID among patients with bacteremia and relate the diagnostic classification to IE-treatment.

Methods
We reanalyzed patient cohorts with Stapylococcus aureus, Staphylococcus lugdunensis, non-beta-hemolytic streptococci, Streptococcus-like bacteria, Streptococcus dysgalactiae, Enterococcus faecalis and HACEK bacteremia. Episodes were classified as definite, possible or rejected IE with the modified Duke and Duke-ISCVID criteria. Reclassification included the microbiology criteria, PET-CT and cardiac implanted elect-ronical devices. To calculate sensitivity, patients treated as IE were considered as having IE.

Results
In 4050 episodes of bacteremia, the modified Duke criteria criteria assigned 307episodes (7.6%) as definite IE, 1190 episodes (29%) as possible IE and 2553 episodes (63%) as rejected IE. Using the Duke-ISCVID criteria, 13 episodes (0.3%) were reclassified from possible to definite IE and 475 episodes (12%) were reclassified from rejected to possible IE. With the modified Duke criteria, 79 episodes that were treated as IE were classified as possible IE and eleven of these episodes were reclassified to definite IE with Duke-ISCVID. Applying the decision to treat for IE as reference standard, the sensitivity of the Duke-ISCVID criteria was 80%. None of the 475 episodes reclassified to possible IE were treated as IE.

Conclusions
The Duke-ISCVID criteria reclassified a small proportion of episodes to definite IE at the expense of more episodes of possible IE. Future criteria should minimize the possible group while keeping or improving sensitivity. (Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Clinical Infectious Diseases
volume
78
issue
4
pages
956 - 963
publisher
Oxford University Press
external identifiers
  • pmid:38330240
ISSN
1537-6591
DOI
10.1093/cid/ciae040
language
English
LU publication?
yes
id
345870aa-1a24-4bda-8836-ef60f5fdaf1c
date added to LUP
2024-02-09 08:46:54
date last changed
2024-04-15 07:33:18
@article{345870aa-1a24-4bda-8836-ef60f5fdaf1c,
  abstract     = {{Background<br/>Revised diagnostic criteria for infective endocarditis (IE), the 2023 Duke-ISCVID criteria, were recently presented and need validation. Here, we compare the 2000 modified Duke criteria for IE with Duke-ISCVID among patients with bacteremia and relate the diagnostic classification to IE-treatment.<br/><br/>Methods<br/>We reanalyzed patient cohorts with Stapylococcus aureus, Staphylococcus lugdunensis, non-beta-hemolytic streptococci, Streptococcus-like bacteria, Streptococcus dysgalactiae, Enterococcus faecalis and HACEK bacteremia. Episodes were classified as definite, possible or rejected IE with the modified Duke and Duke-ISCVID criteria. Reclassification included the microbiology criteria, PET-CT and cardiac implanted elect-ronical devices. To calculate sensitivity, patients treated as IE were considered as having IE.<br/><br/>Results<br/>In 4050 episodes of bacteremia, the modified Duke criteria criteria assigned 307episodes (7.6%) as definite IE, 1190 episodes (29%) as possible IE and 2553 episodes (63%) as rejected IE. Using the Duke-ISCVID criteria, 13 episodes (0.3%) were reclassified from possible to definite IE and 475 episodes (12%) were reclassified from rejected to possible IE. With the modified Duke criteria, 79 episodes that were treated as IE were classified as possible IE and eleven of these episodes were reclassified to definite IE with Duke-ISCVID. Applying the decision to treat for IE as reference standard, the sensitivity of the Duke-ISCVID criteria was 80%. None of the 475 episodes reclassified to possible IE were treated as IE.<br/><br/>Conclusions<br/>The Duke-ISCVID criteria reclassified a small proportion of episodes to definite IE at the expense of more episodes of possible IE. Future criteria should minimize the possible group while keeping or improving sensitivity.}},
  author       = {{Lindberg, Helena and Berge, Andreas and Jovanovic-Stjernqvist, Martin and Hagstrand Aldman, Malin and Krus, David and Öberg, Jonas and Kahn, Fredrik and Bläckberg, Anna and Sunnerhagen, Torgny and Rasmussen, Magnus}},
  issn         = {{1537-6591}},
  language     = {{eng}},
  month        = {{04}},
  number       = {{4}},
  pages        = {{956--963}},
  publisher    = {{Oxford University Press}},
  series       = {{Clinical Infectious Diseases}},
  title        = {{Performance of the 2023 Duke-ISCVID diagnostic criteria for infective endocarditis in relation to the modified Duke criteria and to clinical management- reanalysis of retrospective bacteremia cohorts}},
  url          = {{https://lup.lub.lu.se/search/files/173039712/ciae040.pdf}},
  doi          = {{10.1093/cid/ciae040}},
  volume       = {{78}},
  year         = {{2024}},
}