2023 Duke-International Society for Cardiovascular Infectious Diseases (ISCVID) Criteria

Microorganisms that commonly cause IE isolated from 2 or more separate blood culture sets (typical)

Microorganisms that occasionally or rarely cause IE isolated from 3 or more separate blood culture sets (nontypical)

Positive PCR or other nucleic acid-based technique for Coxiella burnetii, Bartonella species, or Tropheryma whipplei from blood

Coxiella burnetii antiphase I IgG antibody titer >1:800, or isolated from a single blood culture

Indirect IFA for detection of IgM and IgG antibodies to Bartonella henselae or Bartonella quintana with IgG titer ≥1:800

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

Significant new valvular regurgitation on echocardiography as compared with previous imaging. Worsening or changing of preexisting regurgitation is not sufficient.

New partial dehiscence of prosthetic valve as compared with previous imaging

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

Evidence of IE documented by direct inspection during heart surgery without meeting major imaging criteria or subsequent histologic or microbiologic confirmation

Previous history of IE

Prosthetic valve

Previous valve repair

Congenital heart disease

More than mild regurgitation or stenosis of any etiology

Endovascular CIED

Hypertrophic obstructive cardiomyopathy

Injection drug use

Fever with a documented temperature >38.0°C (100.4°F)

Vascular phenomena, including clinical or radiological evidence of arterial emboli, septic pulmonary infarcts, cerebral or splenic abscess, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, Janeway lesions, or purulent purpura

Immunologic phenomena, including positive rheumatoid factor, Osler nodes, Roth spots, or immune complex-mediated glomerulonephritis

Positive blood cultures for a microorganism consistent with IE but not meeting the requirements for major criterion

Positive culture, PCR, or other nucleic acid-based test (amplicon or shotgun sequencing, in situ hybridization) for an organism consistent with IE 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

Abnormal metabolic activity as detected by [18F]FDG PET/CT within 3 months of implantation of prosthetic valve, ascending aortic graft (with concomitant evidence of valve involvement), intracardiac device leads, or other prosthetic material

New valvular regurgitation identified on auscultation, if echocardiography is not available. Worsening or changing of a preexisting murmur is not sufficient.

Microorganisms identified in the context of clinical signs of active endocarditis in a vegetation

(From cardiac tissue, an explanted prosthetic valve or sewing ring, an ascending aortic graft (with concomitant evidence of valve involvement), an endovascular CIED, or an arterial embolus)

Active endocarditis (may be acute or subacute/chronic) identified in or on a vegetation

(From cardiac tissue, an explanted prosthetic valve or sewing ring, an ascending aortic graft (with concomitant evidence of valve involvement), a CIED, or an arterial embolus)