Evaluation of the 2023 Duke–International Society of Cardiovascular Infectious Diseases Criteria in a Multicenter Cohort of Patients With Intravenous Drug Use: A Retrospective Study

Background. Intravenous drug use (IVDU) significantly increases the risk of infective endocarditis (IE). This study evaluates the 2023 Duke–International Society of Cardiovascular Infectious Diseases (ISCVID) criteria for diagnosing IE in patients with a history of IVDU. Methods. This multicenter retrospective study evaluates these criteria in a cohort of 205 patients with intravenous drug use (IVDU) history, comparing outcomes with the 2000 modified Duke criteria. At 2 academic centers, patient records were reviewed for clinical, microbiologic, and imaging data to assess diagnostic classifications. Results. The 2023 Duke-ISCVID criteria reclassified 11 patients (5.3%), primarily due to updates in microbiological criteria, including the inclusion of various streptococcal species and Staphylococcus epidermidis in patients with cardiovascular implantable electronic devices (CIEDs). Notably, an unexpected prevalence of Streptococcus pyogenes as a causative agent was identified in 6 of 20 cases at 1 site. Conclusions. The 2023 Duke-ISCVID criteria reclassified 5% of IE cases in patients with IVDU due to expanded microbiological definitions. The unexpected prevalence of S. pyogenes highlights the need to consider atypical pathogens in high-risk groups.