Unifying Concepts

Modified Duke Criteria for the Clinical Diagnosis of Infective Endocarditis (IE)

The diagnosis of infective endocarditis is generally based on clinical, microbiologic, and echocardiographic findings. The Duke criteria have sensitivity and specificity of more than 80% and are the reference criteria for diagnosis.

Modified Duke Criteria for the Clinical Diagnosis of Infective Endocarditis

Major criteria:

A. Positive blood culture for Infective Endocarditis

1- Typical microorganism consistent with IE from 2 separate blood cultures, as noted below:

    • viridans streptococci, Streptococcus bovis, or HACEK* group, or

    • community-acquired Staphylococcus aureus or enterococci, in the absence of a primary focus


2- Microorganisms consistent with IE from persistently positive blood cultures defined as:

    • 2 positive cultures of blood samples drawn >12 hours apart, or

    • all of 3 or a majority of 4 separate cultures of blood (with first and last sample drawn 1 hour apart)

B. Evidence of endocardial involvement

1- Positive echocardiogram for IE defined as :

· 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, or

· abscess, or

· new partial dehiscence of prosthetic valve


2- New valvular regurgitation (worsening or changing of preexisting murmur not sufficient)

Minor criteria:

  • Predisposition: predisposing heart condition or intravenous drug use
  • Fever: temperature > 38.0° C (100.4° F)
  • Vascular phenomena: major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, and Janeway lesions
  • Immunologic phenomena: glomerulonephritis, Osler’s nodes, Roth spots, and rheumatoid factor
  • Microbiological evidence: positive blood culture but does not meet a major criterion as noted above¹ or serological evidence of active infection with organism consistent with IE
  • Echocardiographic findings: consistent with IE but do not meet a major criterion as noted above

Clinical criteria for infective endocarditis requires:

  • Two major criteria, or
  • One major and three minor criteria, or
  • Five minor criteria

*HACEK group: Haemophilus sp, Actinobacilius actinomycetemcomitans, Cardiobacterium hominis, Eikenella rodens y Kingella sp


References :

  1. Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med. 1994 Mar;96(3):200-9. [Medline]
  2. Hoen B, Duval X. Clinical practice. Infective endocarditis. N Engl J Med. 2013 Apr 11;368(15):1425-33. [Medline]
  3. Chambers HF, Bayer AS. Native-Valve Infective Endocarditis. N Engl J Med. 2020;383(6):567-576. [Medline]
Created: July 14, 2005
Update: Aug 12, 2020
  • Language:

  • Users Online

  • Medical Disclaimer

    El contenido de este sitio web son solo para fines informativos y no reemplazan la consulta con un profesional médico.
  • Recent Posts

  • Categories

  • Copyright by