Comparison of the 2023 ISCVID and ESC Duke clinical criteria for the diagnosis of infective endocarditis among patients with positive blood cultures for new typical microorganisms.

PURPOSE: To evaluate the performance of the Duke clinical criteria of the European Society of Cardiology (ESC; 2015 and 2023 versions) and the 2023 International Society for Cardiovascular Infectious Diseases (ISCVID) in diagnosing infective endocarditis (IE) among patients with bacteraemia/candidaemia by pathogens introduced for the first time as typical microorganisms by ISCVID.

METHODS

Retrospective study.

SETTING

This study included adult patients with bacteraemia/candidaemia by such pathogens (coagulase negative staphylococci, Abiotrophia spp., Gemella spp., and Granulicatella spp., Cutibacterium. acnes, Corynebacterium striatum, C. jeikeium, Pseudomonas aeruginosa, Serratia marcescens, non-tuberculous mycobacteria, and Candida spp.) hospitalized at Lausanne University Hospital. Episodes were classified as IE by two expert clinicians.

RESULTS

Among 463 episodes with bacteraemia/candidaemia by such pathogens, IE was diagnosed in 63 episodes (14%). IE prevalence was 17% among episodes with bacteraemia by Staphylococcus lugdunensis or Abiotrophia spp. No case of IE was identified among Granulicatella spp. and Gemella spp. bacteraemias. Among 113 episodes with intracardiac prosthetic material, IE prevalence was 51% in episodes with bacteraemia by S. epidermidis. Sensitivity for the 2015 Duke-ESC, 2023 Duke-ISCVID, and the 2023 Duke-ESC clinical criteria was calculated at 5%, 57%, and 8%, respectively. More episodes were classified as possible IE by the 2023 Duke-ISCVID (30%) compared to 2015 Duke-ESC (13%) and 2023 Duke-ESC (16%) clinical criteria.

CONCLUSION

The 2023 ISCVID version demonstrated superior sensitivity compared to both 2015 and 2023 Duke-ESC in diagnosing IE caused by new typical microorganisms, compared to the other criteria, albeit an increase in cases being classified as possible IE.