Evaluation of the 2023 Duke-ISCVID and 2023 Duke-ESC Clinical Criteria for the Diagnosis of Infective Endocarditis in a Multicenter Cohort of Patients With Staphylococcus aureus Bacteremia

Matthaios Papadimitriou-Olivgeris; Pierre Monney; Michelle Frank; Georgios Tzimas; Piergiorgio Tozzi; Matthias Kirsch; Mathias Van Hemelrijck; Robert Bauernschmitt; Jana Epprecht; Benoit Guery; Barbara Hasse

doi:10.1093/cid/ciae003

Evaluation of the 2023 Duke-ISCVID and 2023 Duke-ESC Clinical Criteria for the Diagnosis of Infective Endocarditis in a Multicenter Cohort of Patients With Staphylococcus aureus Bacteremia

Clin Infect Dis. 2024 Mar 20;78(3):655-662. doi: 10.1093/cid/ciae003.

Affiliations

¹ Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
² Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
³ Department of Cardiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
⁴ Department of Cardiac Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁵ Department of Cardiac Surgery, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
⁶ Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.

Abstract

Background: The Duke criteria for infective endocarditis (IE) diagnosis underwent revisions in 2023 by the European Society of Cardiology (ESC) and the International Society for Cardiovascular Infectious Diseases (ISCVID). This study aims to assess the diagnostic accuracy of these criteria, focusing on patients with Staphylococcus aureus bacteremia (SAB).

Methods: This Swiss multicenter study conducted between 2014 and 2023 pooled data from three cohorts. It evaluated the performance of each iteration of the Duke criteria by assessing the degree of concordance between definite S. aureus IE (SAIE) and the diagnoses made by the Endocarditis Team (2018-23) or IE expert clinicians (2014-17).

Results: Among 1344 SAB episodes analyzed, 486 (36%) were identified as cases of SAIE. The 2023 Duke-ISCVID and 2023 Duke-ESC criteria demonstrated improved sensitivity for SAIE diagnosis (81% and 82%, respectively) compared to the 2015 Duke-ESC criteria (75%). However, the new criteria exhibited reduced specificity for SAIE (96% for both) compared to the 2015 criteria (99%). Spondylodiscitis was more prevalent among patients with SAIE compared to those with SAB alone (10% vs 7%, P = .026). However, when patients meeting the minor 2015 Duke-ESC vascular criterion were excluded, the incidence of spondylodiscitis was similar between SAIE and SAB patients (6% vs 5%, P = .461).

Conclusions: The 2023 Duke-ISCVID and 2023 Duke-ESC clinical criteria show improved sensitivity for SAIE diagnosis compared to 2015 Duke-ESC criteria. However, this increase in sensitivity comes at the expense of reduced specificity. Future research should aim at evaluating the impact of each component introduced within these criteria.

Keywords: Staphylococcus aureus; Duke criteria; bacteremia; echocardiography; infective endocarditis.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Bacteremia* / diagnosis
Bacteremia* / epidemiology
Cardiology*
Discitis*
Endocarditis* / diagnosis
Endocarditis, Bacterial* / diagnosis
Endocarditis, Bacterial* / epidemiology
Humans
Staphylococcal Infections* / diagnosis
Staphylococcal Infections* / epidemiology
Staphylococcus aureus

Grants and funding

SNSF_/Swiss National Science Foundation/Switzerland