The 2023 Duke-ISCVID criteria update the modified Duke framework for contemporary infective endocarditis classification.

The ISCVID working group noted that IE microbiology, epidemiology, diagnostics and treatment had changed since the original Duke and modified Duke criteria, prompting the 2023 consensus update.
The update broadens major microbiology criteria, incorporates newer imaging evidence such as cardiac CT and FDG PET/CT in appropriate settings, and recognises surgical inspection as a major clinical criterion.
The typical microorganism list and blood-culture timing requirements were revised, with special attention to prosthetic valves, intracardiac devices and contemporary molecular microbiology.
Early validation studies suggest the 2023 criteria can improve sensitivity in selected cohorts, but classification still depends on adequate cultures, imaging quality and expert clinical review.

Interpretation and guardrails

This is a diagnostic classification framework, not a treatment decision rule.
Classification criteria support diagnostic consistency but do not replace infectious diseases and cardiology review when clinical suspicion remains high.
Possible or definite IE should prompt review of blood-culture adequacy, organism plausibility, echocardiography quality and whether advanced imaging or surgical/pathology evidence is needed.
For persistent clinical suspicion with insufficient criteria, repeat cultures, repeat echocardiography or advanced imaging may be appropriate according to local endocarditis pathways.
Grouped criteria are intentionally counted once per Duke-ISCVID category; the expanded checklist helps users decide whether that category is satisfied.
Prior antibiotics, culture-negative disease and limited access to cardiac CT/PET can reduce classification sensitivity.

2023 Duke-ISCVID Criteria for Infective Endocarditis