Clinical Criteria for Infective Endocarditis According to the 2023 Duke-International Society for Cardiovascular Infectious Disease

Major criteria

Microbiology:

1. Two or more positive separate sets of blood cultures for organisms typical of endocarditis OR

Three or more positive separate sets of blood cultures for organisms that rarely or occasionally cause endocarditis

2. PCR or other nucleic acid technique that identifies Coxiella burnetii, Bartonella species, or Tropheryma whipplei from blood OR

Serologic evidence of Coxiella burnetii (IgG titer > 1:800) or 1 positive blood culture for Coxiella burnetii OR

Indirect immunofluorescence assays for detection of IgM and IgG antibodies to Bartonella henselae or Bartonella quintana (IgG titer> 1:800)

Imaging (eg, echocardiographic, CT, [18F]-FDG-PET/CT(A):

• 1. Echocardiography and/or cardiac CT showing vegetation, valvular/leaflet perforation/aneurysm, abscess, pseudoaneurysm, or intracardiac fistula OR

• Echocardiography showing significant new valvular regurgitation. Worsening or changing of preexisting regurgitation is not sufficient. OR

• New partial dehiscence of prosthetic valve (compared with previous imaging)

• 2. [18F]-FDG-PET/CT imaging with abnormal metabolic activity involving a native or prosthetic valve (at least 3 months after valve implantation), ascending aortic graft (with concomitant evidence of valve involvement), intracardiac device leads, or other prosthetic material

Surgical:

Evidence of infective endocarditis observed on direct inspection during cardiac surgery.

Minor criteria

Predisposition:

,

• Previous history of infective endocarditis,

• Prosthetic valve

• Previous valve repair

• Congenital heart disease

• More than mild regurgitation or stenosis of any etiology

• Endovascular intracardiac implantable electronic device

• Hypertrophic obstructive cardiomyopathy

• Injection drug use

Fever ≥ 38.0° C (≥ 100.4°F)

Vascular phenomena (confirmed by clinical or imaging evidence):

• Arterial embolism

• Septic pulmonary infarction

• Abscess of the cerebrum or spleen

• Mycotic aneurysm

• Intracranial hemorrhage

• Conjunctival hemorrhage

• Janeway lesions

• Purulent purpura

Immunologic phenomena:

• Immune complex glomerulonephritis

• Osler nodes

• Roth spots

• Rheumatoid factor

Microbiologic evidence of infection consistent with but not meeting major criteria:

1. Blood culture showing an organism consistent with infective endocarditis OR

2. Positive culture, PCR, or other nucleic acid–based test for an organism consistent with infective endocarditis from a sterile body site other than cardiac tissue, cardiac prosthesis, or arterial embolus; or a single finding of a skin bacterium by PCR on a valve or wire without additional clinical or microbiological supporting evidence

Imaging criteria:

[18F]-FDG-PET/CT imaging with abnormal metabolic activity involving a native or prosthetic valve (within 3 months after valve implantation), ascending aortic graft (with concomitant evidence of valve involvement), intracardiac device leads, or other prosthetic material

Physical examination criteria:

If echocardiography is not available, auscultatory evidence of new valvular regurgitation. Worsening or changing of preexisting regurgitation is not sufficient.