Modified Duke criteria

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Criteria

Major criteria

  • Blood culture positive for IE
    • Typical bacteria from 2 separate blood cultures
      • Viridans streptococci, Streptococcus bovis, HACEK group, Staphylococcus aureus
      • Community-acquired enterococci in the absence of another focus
    • Consistent organisms with persistently-positive blood cultures
      • ≥2 positive cultures drawn >12 h apart
      • 3 or a majority of ≥4 cultures positive, with first and last sample drawn at least 1 h apart
    • Single positive blood culture for Coxiella burnetii or antiphase I IgG antibody titre >1:800
  • Evidence of endocardial involvement
    • Echocardiogram positive for IE
    • New valvular regurgitation

Minor criteria

  • Predisposing heart condition or injection drug use
  • Fever >38ºC
  • Vascular phenomena
    • Major arterial emboli
    • Septic pulmonary infarcts
    • Mycotic aneurysm
    • Intracranial hemorrhage
    • Conjunctival hemorrhages
    • Janeway lesions
  • Immunologic phenomena
    • Glomerulonephritis
    • Osler nodes
    • Roth spots
    • Rheumatoid factor
  • Positive blood cultures not meeting a major criterion, or consistent serology that is not Coxiella

Interpretation

  • Definite infective endocarditis if meets pathologic criteria, or if one of:
    • 2 major, or
    • 1 major and 3 minor, or
    • 5 minor
  • Possible infective endocarditis if one of
    • 1 major and 1 minor, or
    • 3 minor