Guidelines
Infectious Endocarditis

Infectious Endocarditis

Microbiology

Risk Assessment

Major Clinical Criteria Includes:

  • Positive blood cultures (one of the following):
    • Typical microorganisms consistent with IE from two separate blood cultures
    • Persistently positive blood cultures: at least two positive blood cultures from blood samples drawn > 12 hours apart, or Three or a majority of ≥ 4 separate blood cultures (with first and last drawn at least one hour apart
  • Single positive blood culture for Coxiella burnetii or phase I IgG antibody titer > 1:800
  • Evidence of endocardial involvement (by one of the following):
    • Echocardiography (TTE or TEE) positive for IE

Minor Clinical Criteria Includes:

  • Fever: Temperature ≥ 38.0°C (100.4°F)
  • History of IVDU
  • Vascular phenomena
    • Major arterial emboli,
    • Septic pulmonary infarcts,
    • Mycotic aneurysm,
    • Intracranial hemorrhage,
    • Conjunctival hemorrhages, OR
    • Janeway lesions
  • Immunologic phenomena
    • Glomerulonephritis,
    • Osler nodes,
    • Roth spots, OR
    • Rheumatoid factor
  • Microbiologic evidence
    • Positive blood cultures that do not meet major criteria, OR
    • Serologic evidence of active infection with organism consistent with IE

Clinical Considerations

  • Pathologic lesions (vegetation or intracardiac abscess demonstrating active endocarditis on histology) OR
  • Microorganism demonstrated by culture or histology of a vegetation or intracardiac abscess

Using Modified DUKA Criteria:

  • 2 major clinical criteria, OR
  • 1 major and 3 minor clinical criteria, OR
  • 5 minor clinical criteria
  • Presence of 1 major and 1 minor clinical criteria, OR
  • Presence of 3 minor clinical criteria
  • A firm alternate diagnosis is made, OR
  • Resolution of clinical manifestations occurs after ≤4 days of antibiotic therapy, OR
  • No pathologic evidence of infective endocarditis is found at surgery or autopsy after antibiotic therapy for 4 days or less
  • Clinical criteria for possible or definite IE not met

More Information

Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Tleyjeh IM, Rybak MJ, Barsic B, Lockhart PB, Gewitz MH, Levison ME, Bolger AF, Steckelberg JM, Baltimore RS, Fink AM, O'Gara P, Taubert KA;  Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation. 2015 Oct 13;132(15):1435-86. 

doi: 10.1161/CIR.0000000000000296.

Epub 2015 Sep 15. Erratum in: Circulation. 2015 Oct 27;132(17):e215. Erratum in: Circulation. 2016 Aug 23;134(8):e113. Erratum in: Circulation. 2018 Jul 31;138(5):e78-e79. PMID: 26373316.