Duke criteria for the diagnosis of infective endocarditis and proposed modifications
| Duke criteria | Suggested modifications | |
|---|---|---|
| CRP, C reactive protein; ESR, erythrocyte sedimentation rate; IE, infective endocarditis. | ||
| Adapted with permission from Naber CK, Erbel R. Heart2003;:–3. | ||
| Pathological criteria | ||
| Microorganisms demonstrated by culture or histological examination | ||
| Active endocarditis demonstrated by histological examination | ||
| Major criteria | ||
| Positive blood cultures | To be added: | |
| –typical microorganisms consistent with endocarditis from two separate blood cultures | –positive serology for Coxiella burnetti7,8 | |
| –microorganisms consistent with endocarditis from persistently positive blood cultures | –bacteraemia due to Staphyloccocus aureus8 | |
| Evidence of endocardial involvement | –positive molecular assay for specific gene targets and universal loci for bacteria and fungi13 | |
| –echocardiography: oscillating structures, abscess formation, new partial dehiscence of prosthetic valve | ||
| –positive serology for Chlamydia psittaci9 | ||
| –new valvar regurgitation | –positive serology for Bartonella species9 | |
| Minor criteria | ||
| –predisposing heart disease | To be omitted: | |
| –fever >38°C | Suspect echocardiography (no major criterion)8 | |
| –vascular phenomena | To be added: | |
| –immunological phenomena | Elevated CRP, elevated ESR, splenomegaly, haematuria, clubbing, splinter haemorrhages, petechiae and purpura6 | |
| –microbiological evidence (no major criterion) | ||
| –suspect echocardiography (no major criterion) | ||
| Identified IE organism from metastatic lesions12 | ||
| Categories | ||
| Definite: | Pathological criteria positive | |
| or 2 major criteria positive | ||
| or 1 major and 2 minor criteria positive | ||
| or 5 minor criteria positive | ||
| Possible: | All cases which cannot be classified as definite or rejected | 1 major and 1 minor criterion positive8 |
| 3 minor criteria positive8 | ||
| Rejected: | Alternative diagnosis | |
| Resolution of the infection with antibiotic treatment for ⩽4 days | ||
| No histological evidence | ||