Modified Duke Criteria for the Diagnosis of Infective Endocarditis
| Type of criterion | Description of criterion |
|---|
| Major | - Typical microorganisms from two sets of blood cultures:
- Viridans group streptococci, S. bovis group, HACEK group or S. aureus, or
- Community-acquired enterococci with no primary focus, or
- Persistently positive with microorganisms consistent with IE (>2 taken more than 12h apart, or all of three positives or a majority of >4 drawn over a period of 1h), or
- Single positive blood culture for Coxiella burnetii or phase I IgG antibody titre>1:800
- Imaging positive*:
- Vegetations
- Local complication (abscess, fistula, pseudoaneurysm)
- New prosthetic valve dehiscence
- New valve regurgitation or valve destruction
|
| Minor | - Known predisposition to endocarditis (including intravenous drug use)
- Temperature >38°C
- Vascular phenomena (e.g. arterial embolus, intracranial haemorrhage)
- Immunological features (e.g. glomerulonephritis, Osler's nodes, positive rheumatoid factor)
- Positive blood culture but insufficient for major criteria or serological evidence of active infection with an organism consistent with IE
|
Definite IE: Two major criteria, or one major and three minor criteria or five minor criteria.
Possible IE: Illness consistent with IE that falls short of Definite but is not Rejected.
IE rejected: Firm alternative diagnosis; resolution with ≤4 days of antibiotics; no evidence of IE at surgery/autopsy after ≤4 days of antibiotics).
* PET/CT is included in the 2015 ESC guidelines as a major criterion although little high quality data exist on its diagnostic accuracy.