Performance of different versions of Duke criteria in diagnosing infective endocarditis in patients with intracardiac prosthetic materials

Background Diagnosing infective endocarditis (IE) is a significant challenge. This study aimed to compare the diagnostic performance of the 2015 and 2023 European Society of Cardiology (ESC) and the 2023 International Society for Cardiovascular Infectious Diseases (ISCVID) Duke clinical criteria in a cohort of patients with suspected IE and intracardiac prosthetic material. Methods This retrospective study was conducted at two Swiss University Hospitals (2014-2024). The reference standard was the diagnosis of the Endocarditis Team or expert clinicians. Patients with IE (reference standard) classified as definite IE by the Duke criteria were considered true positives, while those without IE classified as rejected IE were considered true negatives. Results Of the 1025 episodes with suspected IE and intracardiac prosthetic material, 537 (61%) had IE. Using the 2015 ESC, 2023 ESC, and 2023 ISCVID clinical criteria, 324 (32%), 367 (36%), and 430 (42%) episodes were classified as definite IE, respectively. The sensitivity for the 2015 Duke-ESC, 2023 Duke-ESC, and 2023 Duke-ISCVID the clinical criteria was calculated to be 56% (95% CI: 52-60%), 61% (57-65%), and 71% (67-74%), respectively, while the specificity 67% (63-71%), 56% (51-61%), and 34% (29-38%), respectively. Conclusions The 2023 ISCVID Duke clinical criteria demonstrated the highest sensitivity for diagnosing IE compared to the 2015 and 2023 ESC Duke criteria in patients with intracardiac prosthetic material. However, this was at the expense of specificity.