Modified Duke 2023: Major Criteria

Modified Duke 2023: Major Criteria

Major Criteria

Microbiologic Criteria

  • Staphylococcus aureus
  • Staphylococcus lugdunensis
  • Enterococcus faecalis
  • all streptococcal species (except for S. pneumoniae and S. pyogenes)
  • Granulicatella and Abiotrophia spp.
  • Gemella spp.
  • HACEK group microorganisms (Haemophilus species, Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae)
  • In the setting of intracardiac prosthetic material, the following additional bacteria should be included as “typical” pathogens:
    • coagulase negative staphylococci
    • Corynebacterium striatum and C. jeikeium
    • Serratia marcescens
    • Pseudomonas aeruginosa
    • Cutibacterium acnes
    • non-tuberculous mycobacteria (especially M. chimaerae)
    • Candida spp.

Imaging Criteria

Worsening or changing of pre-existing regurgitation is not sufficient

  • Performed at least 3 months after prosthetic valve surgical implantation
  • Abnormal metabolic activity involving a native or prosthetic valve, ascending aortic graft (with concomitant evidence of valve involvement), intracardiac device leads or other prosthetic material

Surgical Criteria

This major criterion should not be interpreted as giving license to not send appropriate samples for histopathology and microbiological studies