Duke criteria for the diagnosis of infective endocarditis (IE) and proposed modifications
| Duke criteria | Suggested modifications | ||
|---|---|---|---|
| CRP, C reactive protein; ESR, erythrocyte sedimentation rate. | |||
| Reproduced from Prendergast17 with permission. | |||
| 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 burnetti | ||
| Bacteraemia due to Staphylococcus aureus | |||
| Positive molecular assay for specific gene targets and universal loci for bacteria and fungi | |||
| Microorganisms consistent with endocarditis from persistently positive blood cultures | |||
| Positive serology for Chlamydia psittaci | |||
| Evidence of endocardial involvement | Positive serology for Bartonella species | ||
| Echocardiography: oscillating structures, abscess formation, new partial dehiscence of prosthetic valve | |||
| New valvar regurgitation | |||
| Minor criteria | |||
| Predisposing heart disease | To be omitted: | ||
| Fever >38°C | Suspect echocardiography (no major criterion) | ||
| Vascular phenomena | |||
| Immunological phenomena | To be added: | ||
| Microbiological evidence (no major criterion) | Elevated CRP, elevated ESR, splenomegaly, haematuria, clubbing, splinter haemorrhages, petechiae and purpura | ||
| Suspect echocardiography (no major criterion) | |||
| Identified IE organism from metastatic lesions | |||
| 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 positive | |
| 3 minor criteria positive | |||
| Rejected: | Alternative diagnosis | ||
| Resolution of the infection with antibiotic treatment for ⩽4 days | |||
| No histological evidence | |||