Duke criteria for infective endocarditis

Last revised by Joachim Feger on 22 Aug 2021

The Duke criteria are a set of clinical criteria set forward 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:

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: 
  • 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 

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