Duke Criteria for Infective Endocarditis

Diagnostic criteria for endocarditis.

IMPORTANT

Check out the updated 2023 Duke-ISCVID criteria here!

Pathological Criteria

If either is positive, diagnosis is definite (see Evidence for exceptions)

Microorganisms in a vegetation

Demonstrated by culture or histologic examination of a vegetation, a vegetation that has embolized, or an intracardiac abscess specimen.

Pathologic Lesions

Vegetation or intracardiac abscess confirmed by histologic examination showing active endocarditis.

Major Clinical Criteria

If both are positive, diagnosis is definite (see Evidence for exceptions)

Blood cultures positive for endocarditis

Typical microorganisms consistent with IE from 2 separate blood cultures, microorganisms consistent with IE from persistently positive blood cultures, single positive blood culture for Coxiella burnetii or antiphase I IgG antibody titer >1:800.

Evidence of endocardial involvement

Echocardiogram positive for IE, abscess, new partial dehiscence of prosthetic valve, new valvular regurgitation. Note: Worsening or changing of pre-existing murmur NOT sufficient.

Minor Clinical Criteria

If all are positive, diagnosis is definite (see Evidence for exceptions)

Predisposing heart condition or injection drug use

Fever

Vascular phenomena

Major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, and Janeway’s lesions.

Immunologic phenomena

Glomerulonephritis, Osler’s nodes, Roth’s spots, and rheumatoid factor.

Microbiological evidence

Positive blood culture but does not meet a major criterion as noted above or serological evidence of active infection with organism consistent with IE.

Diagnostic Result

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Dr. David Durack

About the creator

David Durack, MD, is an infectious disease specialist who is affiliated with Duke University Hospital and has practiced for 46 years. He received his medical degree from University of Western Australia Faculty of Medicine. Dr. Durack's clinical interests include public health, endocarditis, meningitis, septicemia, MRSA, influenza, and vaccines.

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Duke Criteria for Infective Endocarditis