Duke Criteria for Infective Endocarditis
Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings: Duke Endocarditis Service. Am J Med. 96:200-209, 1994.

Major criteria:
Major criteria:

Typical microorganism consistent with IE from 2 separate blood cultures, as noted below:
  • viridans streptococci, Streptococcus bovis, or HACEK group (what's this?), or
  • community-acquired Staphylococcus aureus or enterococci, in the absence of a primary focus
Microorganisms consistent with IE from persistently positive blood cultures defined as:
  • 2 positive cultures of blood samples drawn >12 hours apart, or
  • all of 3 or a majority of 4 separate cultures of blood (with first and last sample drawn 1 hour apart)

Positive echocardiogram for IE defined as:
  • oscillating intracardiac mass on valve or supporting structures, in the path of regurgitant jets, or on implanted material in the absence of an alternative anatomic explanation, or
  • abscess, or
  • new partial dehiscence of prosthetic valve
New valvular regurgitation (worsening or changing of preexisting murmur not sufficient)

Minor criteria:
: predisposing heart condition or intravenous drug use
: temperature > 38.0 C (100.4 F)
: major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, and Janeway lesions
: glomerulonephritis, Osler's nodes, Roth spots (what's this?), and rheumatoid factor
: positive blood culture but does not meet a major criterion as noted above¹ or serological evidence of active infection with organism consistent with IE
: consistent with IE but do not meet a major criterion as noted above

¹ Excludes single positive cultures for coagulase-negative staphylococci, diphtheroids, and organisms that do not commonly cause endocarditis.

Duke Clinical Criteria for Infective Endocarditis:

Clinical criteria for infective endocarditis requires:
  • Two major criteria, or
  • One major and three minor criteria, or
  • Five minor criteria
  • Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. American Journal of Medicine. 96(3):200-9, 1994.

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