Newly recognized typical microorganisms in intracardiac prosthetic material-related infective endocarditis: evidence behind their inclusion in the 2023 Duke-ISCVID criteria.

PURPOSE: The 2023 Duke-International Society for Cardiovascular Infectious Diseases (Duke-ISCVID) Criteria classified coagulase-negative staphylococci (CoNS), Corynebacterium striatum, Corynebacterium jeikeium, Serratia marcescens, Pseudomonas aeruginosa, Cutibacterium acnes, non-tuberculous mycobacteria, and Candida species as typical microorganisms when intracardiac prosthetic material is present. We critically appraised the evidence supporting these additions and their diagnostic implications.

METHODS

We conducted a focused narrative review of observational cohorts, bloodstream-infection studies, systematic reviews, and international guidance, supplemented by relevant studies identified during peer review. We distinguished prosthetic valve and CIED-lead endocarditis from pocket and left ventricular assist device infections.

RESULTS

Evidence was strongest for CoNS, C. acnes, and Candida species; moderate but limited by rarity for C. striatum/C. jeikeium and non-tuberculous mycobacteria; and less consistent or indirect for S. marcescens and P. aeruginosa. Comparative validation studies indicate that the diagnostic impact of the expanded Duke-ISCVID microbiological criteria is population- and organism-dependent. The largest sensitivity gains have been observed in populations directly affected by the newly designated typical microorganisms, whereas differences are smaller in broader IE cohorts and may be accompanied by changes in specificity and reclassification as possible IE.

CONCLUSION

The expanded criterion may improve case ascertainment and should prompt targeted evaluation in patients with intracardiac prosthetic material. However, its diagnostic contribution is not uniform across microorganisms, and fulfilment of the microbiological major criterion should not be interpreted as confirmation of IE in isolation. Multimodality imaging, assessment of bloodstream-infection source and persistence, and clinical judgement remain essential.