Duke criteria for infective endocarditis

Last revised by Calum Worsley on 19 Feb 2024

The Duke criteria are a set of clinical criteria set forward for the diagnosis of infective endocarditis.

For diagnosis of definite infective endocarditis by clinical criteria the requirement is 4

  • 2 major criteria or

  • 1 major and 3 minor criteria or

  • 5 minor criteria

For diagnosis of possible infective endocarditis by clinical criteria the requirement is 4:

  • 1 major and 1 minor criterion

  • 3 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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