Infective Endocarditis (IE)
Modified Duke Criteria

Modified Duke Criteria

Definition of Terms

  • Blood culture positive for IE
  • Typical microorganisms consistent with IE from 2 separate blood cultures (Viridans streptococci, Streptococcus bovis, HACEK group, Staphylococcus
    aureus, or community-acquired enterococci in the absence of a primary focus) OR microorganisms consistent with IE from persistently positive blood cultures defined as follows:
    • At least 2 positive cultures of blood samples drawn >12 h apart or all 3 or a majority of ≥4 separate cultures of blood (with first and last sample drawn at least 1 h apart)
  • Single positive blood culture for Coxiella burnetii or anti-phase 1 IgG antibody titer ≥1:800
  • Evidence of endocardial involvement
  • Echocardiogram positive for IE (TEE recommended for patients with prosthetic valves, rated at least possible IE by clinical criteria, or complicated IE [paravalvular abscess); TTE as first test in other patients) defined as follows:
    • Oscillating intracardiac mass on valve or supporting structures, in the path of regurgitant jets, or on implanted material in the absence of an alternative anatomic explanation; abscess; or new partial dehiscence of prosthetic valve or new valvular regurgitation (worsening or changing or pre-existing murmur not sufficient)
  • Predisposition, predisposing heart condition, or injection drug use
  • Fever, temperature >38°C
  • Vascular phenomena, major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, and Janeway lesions
  • Immunological phenomena: glomerulonephritis, Osler nodes, Roth spots, and rheumatoid factor
  • Microbiological evidence
    • Positive blood culture but does not meet a major criterion as noted above (excludes single positive cultures for coagulase-negative staphylococci and organisms that do not cause endocarditis), OR
    • Serological evidence of active infection with organism consistent with IE

Indicates Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species

Definition of IE According to the Modified Duke Criteria

Pathological criteria

  • Microorganisms demonstrated by culture or histological examination of a vegetation, a vegetation that has embolized, or an intracardiac abscess specimen; OR
  • Pathological lesions; OR
  • Vegetation or intracardiac abscess confirmed by histological examination showing active endocarditis

Clinical criteria

  • 2 major criteria, OR
  • 1 major criterion and 3 minor criteria, OR
  • 5 minor criteria
  • 1 major criterion and 1 minor criterion, OR
  • 3 minor criteria
  • Firm alternative diagnosis explaining evidence of IE; OR
  • Resolution of IE syndrome with antibiotic therapy for ≤4 d; OR
  • No pathological evidence of IE at surgery or autopsy with antibiotic therapy for ≤4 d; OR
  • Does not meet criteria for possible IE as above

Additional Information

These criteria have been universally accepted and are in current use. Reprinted from Li et al. by permission of the Infectious Diseases Society of America. Copyright © 2000, the Infectious Diseases Society of America.