Cardiology Infectious Disease

2023 Duke-ISCVID Criteria for Infective Endocarditis

Updated 2023 Duke criteria incorporating CT, PET-CT, and MRI findings for IE diagnosis. Classification: Definite, Possible, or Rejected.

Major: Positive blood cultures typical for IE

≥2 positive blood cultures with typical organisms (Strep viridans, Strep bovis, HACEK, S. aureus, Enterococcus without primary focus) OR persistently positive cultures > 12h apart OR ≥3 of ≥4 positive cultures

Yes

Major: Positive imaging — Echocardiography / CT / nuclear imaging

Vegetation, abscess, pseudoaneurysm, fistula, valvular perforation, new valvular regurgitation, new prosthetic dehiscence on echo; OR CT/PET-CT showing abnormal activity around prosthetic valve or vascular graft

Yes

Minor: Predisposing heart condition or IV drug use

Prosthetic valve, prior IE, congenital heart disease, other predisposing condition, or IVDU

Yes

Minor: Fever ≥ 38°C (100.4°F)

Yes

Minor: Vascular phenomena

Major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial haemorrhage, conjunctival haemorrhage, Janeway lesions

Yes

Minor: Immunological phenomena

Glomerulonephritis, Osler nodes, Roth spots, positive rheumatoid factor

Yes

Minor: Microbiological evidence — positive blood culture not meeting major criterion

Positive blood culture not meeting major criteria, OR serological evidence of active infection with organism consistent with IE

Yes

Minor: New valvular regurgitation (not sufficient for major criterion)

Yes

Score interpretation

Rejected 0–9

Insufficient criteria for IE. Alternative diagnosis more likely, OR symptoms resolve with ≤4 days of antibiotics.

→ Reassess for alternative diagnoses. Repeat blood cultures if clinical suspicion persists.

Possible Infective Endocarditis 10–19

1 major + 1 minor criteria, OR ≥3 minor criteria. Possible IE.

→ Continue workup. Repeat blood cultures. Echocardiography (TTE then TOE). Specialist ID/Cardiology review.

Definite Infective Endocarditis 20–100

2 major OR 1 major + 3 minor OR ≥5 minor criteria. Definite IE. Also definite if pathological criteria met.

→ Commence IV antibiotics per local protocol. Cardiothoracic surgery consultation. IE MDT team activation.

Interpretation bands for the Duke-ISCVID 2023. Apply clinical judgement and local guidance.

References

Fowler VG et al. 2023 Duke-ISCVID Criteria for Infective Endocarditis: Updating the Modified Duke Criteria. Clin Infect Dis. 2023;77(4):518-526.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

📚 MRCEM Revision

Featured in these MRCEM clinical pathways

The Duke-ISCVID 2023 is covered in detail — with RCEM/NICE evidence base, indications and pitfalls — in the following exam-focused pathways on our sister siteReviseMRCEM.

Infectious Diseases ED

MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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