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Dukes criteria

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2023 Duke ISCVID criteria infective endocarditis major minor criteria official

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Modified Duke criteria for infective endocarditis

Major criteria

  1. Positive blood cultures for infective endocarditis
    • Typical organism from 2 separate blood cultures:
      • Viridans streptococci
      • Streptococcus gallolyticus (formerly S. bovis)
      • HACEK organisms
      • Staphylococcus aureus
      • Community-acquired enterococci, with no primary focus
    • Or persistent bacteraemia:
      • 2 positive cultures drawn >12 hours apart, or
      • all 3 of 3, or a majority of 4 or more cultures positive, with first and last samples at least 1 hour apart
    • Or a single positive blood culture for Coxiella burnetii, or phase-I IgG antibody titre >1:800.
  2. Evidence of endocardial involvement
    • Echocardiographic vegetation, abscess, or new partial dehiscence of a prosthetic valve
    • New valvular regurgitation. A change in a pre-existing murmur alone does not qualify.

Minor criteria

  1. Predisposition: pre-existing cardiac lesion or intravenous drug use
  2. Fever: temperature ≥38°C
  3. Vascular phenomena: arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial haemorrhage, conjunctival haemorrhages, Janeway lesions
  4. Immunologic phenomena: glomerulonephritis, Osler nodes, Roth spots, rheumatoid factor
  5. Microbiological evidence not fulfilling a major criterion, including compatible serology

Diagnostic interpretation

CategoryCriteria
Definite infective endocarditisPathological proof or 2 major or 1 major + 3 minor or 5 minor
Possible infective endocarditis1 major + 1 minor or 3 minor
RejectedFirm alternative diagnosis, resolution with ≤4 days of antibiotics, or lack of pathological evidence at surgery/autopsy after ≤4 days of antibiotics

Pathological definite IE

Microorganisms demonstrated by culture or histology in a vegetation, embolus, or intracardiac abscess, or histological evidence of active endocarditis.
Current update: The 2023 Duke-ISCVID criteria retain the major/minor structure but broaden microbiological testing and imaging. Cardiac CT, FDG-PET/CT in selected prosthetic material/device cases, and direct surgical inspection can contribute to major criteria. See the 2023 Duke-ISCVID update.
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