Item C29B.

Modified Duke Criteria for the Diagnosis of Infective

Endocarditis.
Definite IE
Pathological Criteria
1. Microorganisms demonstrated by culture or histologic testing in a vegeta-
tion, embolized vegetation, or intracardiac abscess; or
2. Pathologic lesions (vegetation or intracardiac abscess) with active endo-
carditis confirmed by histologic testing
Clinical Criteria: 2 major criteria, 1 major and 3 minor criteria, or 5 minor criteria
Major Criteria
1. Positive blood culture result for IE
a. Typical microorganism consistent with IE from 2 separate blood
cultures:
i. Viridans streptococci
ii. Streptococcus bovis
iii. AAECK group
iv. Staphylococcus aureus
v. Community-acquired enterococci (without a primary focus)
b. Microorganism consistent with IE from blood cultures with persistently
positive results if:
i. At least 2 positive results of blood cultures sampled more than 12
hours apart
ii. All 3 or a majority of more than 4 blood cultures
c. Single positive blood culture for Coxiella burnetii or IgG antibody
titer >1:800
2. Evidence of endocardial involvement by echocardiogram result positive for
IE, defined as:
a. Oscillating intracardiac mass on valve or supporting structures in the
path of regurgitant jets or on implanted material
b. Abscess
c. New partial dehiscence of prosthetic valve
d. New valvular regurgitation (worsening or changing of preexisting
murmur not sufficient)
Minor Criteria
1. Predisposing heart condition or intravenous drug abuse
2. Fever: temperature ≥38°C
3. Vascular phenomena: major arterial emboli, septic pulmonary infarcts,
mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages,
Janeway lesions
4. Immunologic phenomena: glomerulonephritis, Osler nodes, Roth spots,
rheumatoid factor
5. Microbiological evidence: positive blood culture result but does not meet
major criteria or serologic evidence of active infection with organism
consistent with IE
Possible IE
1. 1 Major criterion and 1 minor criterion
2. 3 Minor criteria
Rejected
1. Firm alternative diagnosis for manifestation of endocarditis
2. Resolution of endocarditis manifestations with antibiotic therapy ≤4 days
3. No pathologic evidence of IE at surgery or autopsy with antibiotic therapy
for ≤4 days
4. Does not fulfill criteria above
AAECK=Aggregatibacter parainfluenzae, Aggregatibacter actinomycetemcomitans, Cardiobacterium
hominis, Eikenella corrodens, and Kingella species; IE=infective endocarditis.
Adapted and reprinted with permission from Li JS, Sexton DJ, Mick N, et al. Proposed modification to
Duke criteria of diagnosis of infective endocarditis. Clin Infect Dis. 2000; 30(4):633-638.