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. 2022 Sep 29;75(6):1097-1102.
doi: 10.1093/cid/ciac181.

Sign of the Times: Updating Infective Endocarditis Diagnostic Criteria to Recognize Enterococcus faecalis as a Typical Endocarditis Bacterium

Anders Dahl  1   2 , Vance G Fowler  3 , José M Miro  2   4 , Niels E Bruun  5   6
Affiliations

Sign of the Times: Updating Infective Endocarditis Diagnostic Criteria to Recognize Enterococcus faecalis as a Typical Endocarditis Bacterium

Anders Dahl et al. Clin Infect Dis. .

Abstract

The modified Duke criteria requires that Enterococcus faecalis bacteremia must be both community-acquired and without known focus in order to be considered a microbiological "Major" diagnostic criterion in the diagnosis of infective endocarditis. We believe that the microbiological diagnostic criteria should be updated to regard E. faecalis as a "typical" endocarditis bacterium as is currently the case, for example, viridans group streptococci and Staphylococcus aureus. Using data from a prospective study of 344 patients with E. faecalis bacteremia evaluated with echocardiography, we demonstrate that designating E. faecalis as a "typical" endocarditis pathogen, regardless the place of acquisition or the portal of entry, improved the sensitivity to correctly identify definite endocarditis from 70% (modified Duke criteria) to 96% (enterococcal adjusted Duke criteria).

Keywords: community acquired; enterococcal adjusted duke criteria; microbiological; modified duke criteria; sensitivity.

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Conflict of interest statement

Potential conflicts of interest. A. D. is supported by a research grant from The Lundbeck Foundation (grant number R288-2018-1898). A. D. acknowledge funding received from the European Society of Cardiology (ESC) in form of an European Society of Cardiology Research Grant. V. G. F. reports personal fees from Novartis, Novadigm, Durata, Debiopharm, Genentech, Achaogen, Affinium, Medicines Co., Cerexa, Tetraphase, Trius, MedImmune, Bayer, Theravance, Basilea, Affinergy, Janssen, xBiotech, Contrafect, Regeneron, Basilea, Destiny, Amphliphi Biosciences, Integrated Biotherapeutics, C3J, Armata, Valanbio; Akagera, Aridis, and Roche; grants from National Institutes of Health (NIH), MedImmune, Allergan, Pfizer, Advanced Liquid Logics, Theravance, Novartis, Merck, Medical Biosurfaces, Locus, Affinergy, Contrafect, Karius, Genentech, Regeneron, Basilea, Janssen, and Akagera. Royalties from UpToDate; stock options from Valanbio and ArcBio; a patent sepsis diagnostics pending; Northwell Medical Center honoraria for Medical Grand Rounds; support for attending meetings and/or travel from Contrafect; participation on a Data Safety Monitoring Board or Advisory Board for ArcBio, Debiopharm, Basilea, Integrated Biotherapeutics; writing membership of S. aureus bacteremia Treatment Guidelines for the Infectious Diseases Society of America (IDSA); and a stipend from the IDSA for service as Associate Editor on Clinical Infectious Diseases. J. M. M. has received consulting honoraria and/or research grants from AbbVie, Angelini, Contrafect, Cubist, Genentech, Gilead Sciences, Jansen, Lysovant, Medtronic, MSD, Novartis, Pfizer, and ViiV Healthcare, outside the submitted work. J. M. M. received a personal 80:20 research grant from Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, during 2017–2021. N. E. B. has received an unrestricted research grant from the Novo Nordisk Foundation, the Augustinus Foundation, the Kaj Hansen Foundation, and Health Insurance Denmark, not related to this article. N. E. B. also reports annual payments for writing two chapters for the textbook “MEDECIN.” All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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