The modified Duke Criteria are used for the diagnosis of endocarditis.
**Major criterion for blood culture positive for endocarditis:
- 2 separate blood cultures with typical microorganisms in endocarditis:
- Staphylococcus aureus
- Streptococcus viridans
- Streptococcus bovis including nutritional variant strains
- HACEK group
- Community-acquired Enterococci, in the absence of a primary focus
- Persistently positive blood cultures with microorganisms consistent with endocarditis:
- Two positive cultures of blood samples drawn > 12 hours apart
- 3 of 3 or 3 of 4 separate cultures of blood (with first and last sample drawn 1 hour apart)
- Coxiella burnetii detected by at least one positive blood culture or IgG antibody titer for Q fever phase 1 antigen > 1:800.
Criteria for definite endocarditis:
- 1+ path criteria
- 2 major clinical criteria
- 1 major clinical criterion, 3 minor clinical criteria
- 5 minor criteria
Criteria for possible endocarditis:
- 1 major criterion, 1 minor criterion
- 3 minor criteria
Criteria for rejecting endocarditis:
- Firm alternative diagnosis explaining evidence of endocarditis
- Resolution of syndrome with antibiotics for 4 days
- No path evidence of endocarditis at surgery or autopsy, with antibiotics for 4 days
- Does not meet criteria for possible endocarditis by Duke criteria
Durack DT et al. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med. 1994; 96(3):200-9.
Li JS et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000; 30(4):633-8.
Infective Endocarditis: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Statement for Healthcare Professionals ... Endorsed by the Infectious Diseases Society of America. Circulation. 2005. 111:3167–84.