Modified Duke Criteria (Infective Endocarditis)

These criteria can be used as a guide to diagnose IE with an overall sensitivity of 80%. It is not to replace good clinical judgment to treat each individual patient appropriately.

Pathological criteria metMicroorganisms demonstrated by culture or histology of a vegetation, vegetation that has embolized, or intracardiac abscess specimen

Major criteria (0 selected)

Blood culture positive for IETypical microorganisms consistent with IE from 2 separate blood cultures• Viridans streptococci, Streptococcus gallolyticus/bovis, HACEK group, Staphylococcus aureus OR• Community-acquired enterococci in the absence of a primary focusMicroorganisms consistent with IE from persistently positive blood cultures• ≥ 2 positive blood cultures of blood samples drawn > 12h apart OR• All of 3 or majority of ≥ 4 separate cultures of blood (with first and last samples drawn ≥ 1h apart)Single positive blood culture for Coxiella burnetii or phase I IgG antibody titer > 1:800Imaging positive for IEEchocardiogram positive for IE• Vegetation• Abscess, pseudoaneurysm, intracardiac fistula• Valvular perforation or aneurysm• New partial dehiscence of prosthetic valve

Minor criteria (0 selected)

Predisposition: predisposing heart condition or IV drug useFever > 38°CVascular phenomena (including those detected by imaging only): major arterial emboli, septic pulmonary infarcts, infectious (mycotic) aneurysm, intracranial hemorrhage, conjunctival hemorrhages, Janeway's lesionsImmunological phenomena: glomerulonephritis, Osler's nodes, Roth's spots, rheumatoid factorMicrobiological 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

Rejected IE criteria

Firm alternate diagnosisResolution of symptoms within 4 days with antibiotic therapyNo pathological evidence of IE at surgery or autopsy, with antibiotic therapy ≤ 4 days