Duke criteria

Duke criteria for the diagnosis of infective endocarditis

For diagnosis the requirement is:

• 2 major and 1 minor criterion or
• 1 major and 3 minor criteria or
• 5 minor criteria

For adequate diagnostic sensitivity, transesophageal echocardiography is the preferred modality used in patients designated “high-risk” or those in whom transthoracic echocardiography would likely be difficult. Examples of high-risk patients are those with 3:

• past medical history of endocarditis
• congenital heart disease
• physical exam significant for:
  • signs of heart failure
  • a new heart murmur
  • stigmata of infective endocarditis
• history of prosthetic heart valve implantation

Major criteria

• positive blood cultures for infective endocarditis
• typical microorganism for infective endocarditis from 2 separate blood cultures
  • Viridans streptococci, Streptococcus bovis, and HACEK group or
  • community-acquired Staphylococcus aureus or enterococci in the absence of a primary focus or
  • persistently positive blood cultures, defined as recovery of a microorganism consistent with infective endocarditis from:
    • 2 blood cultures drawn 12 hours apart or all of 3 or most of 4 or more separate blood cultures, with first and last drawn at least one hour apart
• evidence of endocardial involvement
  • positive echocardiogram for infective endocarditis
    • oscillating intracardiac mass on valve or supporting structures or in the path of regurgitant jets or on implanted material in the absence of an alternative anatomical explanation or
    • abscess or
    • new partial dehiscence of prosthetic valve or
  • new valvular regurgitation

Minor criteria

• predisposing heart condition or intravenous drug use
• fever: 38°C
• vascular phenomena: major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, and Janeway lesions
• immunologic phenomena:
  • glomerulonephritis
  • Osler nodes
  • Roth spots
  • rheumatoid factor
• microbiologic evidence: positive blood culture but not meeting major criterion as noted previously or serologic evidence of active infection with organism consistent with infective endocarditis
• echocardiography findings consistent with infective endocarditis but not meeting major criteria as noted previously