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

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


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.

MeSH terms

  • Bacteremia* / diagnosis
  • Bacteremia* / microbiology
  • Bacteria
  • Endocarditis* / microbiology
  • Endocarditis, Bacterial* / diagnosis
  • Endocarditis, Bacterial* / microbiology
  • Enterococcus faecalis
  • Humans
  • Prospective Studies