Duke Criteria Calculator (2023 Duke-ISCVID)

What changed in 2023

The Duke-ISCVID update modernized both arms of the criteria: the microbiologic major now includes enterococcal bacteremia without an obvious focus and PCR/serologic diagnosis of culture-negative organisms, and the imaging major finally admits what practice already knew — ¹⁸F-FDG PET/CT and cardiac CT findings can carry major-criterion weight, particularly around prosthetic material where echo struggles. The skeleton (2 major; 1 major + 3 minor; 5 minor for definite) survives from 1994 because it works.

Endocarditis is a stroke diagnosis until proven otherwise

A substantial minority of IE patients present neurologically — embolic infarcts (often multiple, multi-territory, small and cortical), mycotic aneurysms, ICH, or abscess — and the stroke service is frequently the first to meet them. Three operational rules follow. First, multi-territory embolic-appearing infarcts plus fever, murmur, bacteremia risk, or unexplained inflammatory markers should trigger blood cultures before antibiotics and an echocardiography pathway; the "vascular phenomena" minor criterion means the stroke itself is evidence. Second, IV thrombolysis in stroke from suspected IE is generally avoided — hemorrhage rates are high and the occlusions are septic material, not bland thrombus; mechanical thrombectomy is the reperfusion conversation instead. Third, anticoagulation does not treat the embolic risk of native-valve IE and raises hemorrhage risk in the presence of mycotic aneurysms and hemorrhagic transformation — existing anticoagulation usually gets held early, and antibiotics are what actually shrink embolic risk, most steeply in the first week of effective therapy.