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Table 83-1

The Modified Duke Criteria for the Clinical Diagnosis of Infective Endocarditisa

Major Criteria
  1. Positive blood culture

    Typical microorganism for infective endocarditis from two separate blood cultures

     Viridans streptococci, Streptococcus gallolyticus, HACEK group organisms, Staphylococcus aureus, or

     Community-acquired enterococci in the absence of a primary focus,

     or

    Persistently positive blood culture, defined as recovery of a microorganism consistent with infective endocarditis from:

     Blood cultures drawn >12 h apart; or

     All of 3 or a majority of ≥4 separate blood cultures, with first and last drawn at least 1 h apart

     or

    Single positive blood culture for Coxiella burnetii or phase I IgG antibody titer of >1:800

  2. Evidence of endocardial involvement

    Positive echocardiogramb

     Oscillating intracardiac mass on valve or supporting structures or in the path of regurgitant jets or in implanted material, in the absence of an alternative anatomic explanation, or

     Abscess, or

     New partial dehiscence of prosthetic valve,

     or

    New valvular regurgitation (increase or change in preexisting murmur not sufficient)

Minor Criteria
  1. Predisposition: predisposing heart conditionsc or injection drug use
  2. Fever ≥38.0°C (≥100.4°F)
  3. Vascular phenomena: major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, Janeway lesions
  4. Immunologic phenomena: glomerulonephritis, Osler's nodes, Roth's spots, rheumatoid factor
  5. Microbiologic evidence: positive blood culture but not meeting major criterion, as noted previously,d or serologic evidence of active infection with an organism consistent with infective endocarditis

a Definite endocarditis is defined by documentation of two major criteria, of one major criterion and three minor criteria, or of five minor criteria. See text for further details.

b Transesophageal echocardiography is required for optimal assessment of possible prosthetic valve endocarditis or complicated endocarditis.

c Valvular disease with stenosis or regurgitation, presence of a prosthetic valve, congenital heart disease including corrected or partially corrected conditions (except isolated atrial septal defect, repaired ventricular septal defect, or closed patent ductus arteriosus), prior endocarditis, or hypertrophic cardiomyopathy.

d Excluding single positive cultures for coagulase-negative staphylococci and diphtheroids, which are common culture contaminants, or for organisms that do not cause endocarditis frequently, such as gram-negative bacilli.

Source: Adapted from Li JS et al: Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 30:633, 2000. With permission from Oxford University Press.