The update includes an expanded list of the microorganisms causing the disease and incorporates new imaging and microbiological techniques (metagenomics) for the diagnosis.
The update was coordinated by Dr. Josep M. Miró, Senior Consultant in Infectious Diseases at the Hospital Clínic, Professor of Medicine at the University of Barcelona, Head of the IDIBAPS Endocarditis. Cardiovascular infections. Experimental model research group and Head of the group in the CIBERINFEC, and President of the International Society of Cardiovascular Infectious Diseases (ISCVID); and Dr. Vance G. Fowler, from Duke University (Durham, North Carolina).
Endocarditis is an inflammation of the inner lining of the heart chambers and valves (endocardium). It is a rare but serious disease, and if it is not treated quickly can alter the proper functioning of the heart by damaging the heart valves.
The microbiology, epidemiology, diagnosis and treatment of infective endocarditis (IE) have changed significantly since the publication of the initial criteria in 1994, which were updated in 2001. Now, to prepare these new guidelines, the ISCVID has brought together a multidisciplinary group made up of 25 experts in infective endocarditis from five continents and six specialities related to the disease: Anatomical pathology, Cardiology, Cardiovascular surgery, Infectious diseases, Microbiology and Radiology.
At a histopathological level, the update includes genomic diagnostics of heart valve samples. From the microbiological point of view, new microorganisms causing endocarditis have been added and the methodologies to determine them. In terms of imaging, echocardiography remains the cornerstone of diagnostic imaging and cardiac [18F] FDG PET/CT and CT have been added as major criteria.
The document also outlines the two main challenges in the management of this infection. The first is that these new 2023 Duke-ISCVID criteria for infective endocarditis must be validated. “Validation studies are already underway in Europe (France, the Netherlands, Sweden, Spain) to determine their sensitivity and specificity”, explains Dr. Miró. The second is not to let 25 years go by before updating the criteria again. “The ISCVID is committed to updating them periodically on their website as a ‘living’ document, as is done with HIV or HCV. Every four years and, depending on the evidence available, these updated criteria could be published”, he concludes.
Study reference:
The 2023 Duke-ISCVID Criteria for Infective Endocarditis: Updating the Modified Duke Criteria.
Fowler VG, Durack DT, Selton-Suty C, Athan E, Bayer AS, Chamis AL, Dahl A, DiBernardo L, Durante-Mangoni E, Duval X, Fuertes C, Fosbøl E, Hannan MM, Hasse B, Hoen B, Karchmer AW, Maestros CA, Petti CA, Pizzi MN, Preston SD, Roque A, Vandenesch F, van der Meer JTM, van der Vaart TW, Miro JM.
Clin Infect Dis. 2023 May 4:ciad271. doi: 10.1093/cid/ciad271. Online ahead of print. PMID: 37138445
