Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA.
Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
Clin Infect Dis. 2023 Aug 22;77(4):518-526. doi: 10.1093/cid/ciad271.
The microbiology, epidemiology, diagnostics, and treatment of infective endocarditis (IE) have changed significantly since the Duke Criteria were published in 1994 and modified in 2000. The International Society for Cardiovascular Infectious Diseases (ISCVID) convened a multidisciplinary Working Group to update the diagnostic criteria for IE. The resulting 2023 Duke-ISCVID IE Criteria propose significant changes, including new microbiology diagnostics (enzyme immunoassay for Bartonella species, polymerase chain reaction, amplicon/metagenomic sequencing, in situ hybridization), imaging (positron emission computed tomography with 18F-fluorodeoxyglucose, cardiac computed tomography), and inclusion of intraoperative inspection as a new Major Clinical Criterion. The list of "typical" microorganisms causing IE was expanded and includes pathogens to be considered as typical only in the presence of intracardiac prostheses. The requirements for timing and separate venipunctures for blood cultures were removed. Last, additional predisposing conditions (transcatheter valve implants, endovascular cardiac implantable electronic devices, prior IE) were clarified. These diagnostic criteria should be updated periodically by making the Duke-ISCVID Criteria available online as a "Living Document."
自 1994 年杜克标准发布并于 2000 年修订以来，感染性心内膜炎（IE）的微生物学、流行病学、诊断和治疗发生了重大变化。国际心血管感染疾病学会（ISCVID）召集了一个多学科工作组来更新 IE 的诊断标准。由此产生的 2023 年杜克-ISCVID IE 标准提出了重大变化，包括新的微生物学诊断（巴尔通体属酶免疫测定、聚合酶链反应、扩增子/宏基因组测序、原位杂交）、影像学（正电子发射计算机断层扫描 18F-氟脱氧葡萄糖、心脏计算机断层扫描），并将术中检查纳入新的主要临床标准。引起 IE 的“典型”微生物的清单已扩大，包括仅在心内假体存在时才被视为典型病原体的病原体。去除了血液培养物的时间和单独静脉穿刺的要求。最后，对其他易患条件（经导管瓣膜植入物、血管内心脏植入式电子设备、既往 IE）进行了澄清。这些诊断标准应定期更新，将杜克-ISCVID 标准在线作为“活文档”提供。
