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duke criteria
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Duke criteria infective endocarditis 2023 modified
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https://www.mdcalc.com/calc/1731/duke-criteria-infective-end…
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Here is a full breakdown of the 2023 Duke-ISCVID Criteria for Infective Endocarditis (IE) - the current standard, updated from the original 1994 and modified 2000 versions.
Duke Criteria for Infective Endocarditis (2023 Duke-ISCVID)
Classification
| Classification | Criteria |
|---|---|
| Definite IE | Pathologic criteria OR 2 major OR 1 major + 3 minor OR 5 minor |
| Possible IE | 1 major + 1 minor OR 3 minor |
| Rejected | Firm alternate diagnosis; symptom resolution with antibiotics ≤4 days; no pathologic evidence at surgery with antibiotics ≤4 days; does not meet "possible" |
Pathologic Criteria (either one = Definite IE)
- Microorganisms identified in a vegetation, explanted prosthetic valve, aortic graft, CIED, or embolus in the context of active IE
- Histopathological findings of active endocarditis from cardiac tissue, vegetation, prosthetic valve/graft, CIED, or embolus
Major Criteria
A. Microbiologic
- Positive blood cultures:
- Typical IE organisms (e.g., Streptococci, Staph aureus, Enterococci) from 2+ separate blood culture sets
- Occasional/rare IE organisms from 3+ separate blood culture sets
- Positive laboratory test:
- Positive PCR/nucleic acid test from blood for Coxiella burnetii, Bartonella spp., or Tropheryma whipplei
- C. burnetii antiphase IgG antibody titer >1:800 or single positive culture
- Bartonella henselae or B. quintana IgG titer >1:800
B. Imaging
- Echo or cardiac CT showing: vegetation, leaflet perforation/aneurysm, abscess, pseudoaneurysm, intracardiac fistula, new significant valvular regurgitation, or new partial prosthetic valve dehiscence
- 18F-FDG PET/CT: abnormal metabolic activity (at least 3 months post-implant) involving native/prosthetic valve, aortic graft with valve involvement, CIED leads, or other prosthetic material
C. Surgical (new in 2023)
- Direct intraoperative visualization of IE evidence, in the absence of microbiologic or imaging major criteria and pathologic criteria
Minor Criteria
| Category | Criteria |
|---|---|
| A. Predisposition | Prior IE, prosthetic valve, prior valve repair, congenital heart disease, moderate-severe valvular regurgitation/stenosis (any etiology), endovascular CIED, hypertrophic obstructive cardiomyopathy, injection drug use |
| B. Fever | Temp ≥38.0°C (100.4°F) |
| C. Vascular phenomena | Arterial emboli, septic pulmonary infarcts, cerebral/splenic abscess, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, Janeway lesions, purulent purpura, thromboembolic phenomena |
| D. Immunologic phenomena | Positive rheumatoid factor, Osler's nodes, Roth's spots, immune complex-mediated glomerulonephritis |
| E. Microbiologic (sub-major) | Positive blood cultures not meeting major criteria; positive culture/PCR from sterile site other than cardiac tissue |
| F. Imaging (sub-major) | Abnormal FDG PET/CT within 3 months of prosthetic implant (which doesn't qualify as major) |
| G. Physical exam | New valvular regurgitation on auscultation |
Key Updates in 2023 vs. Modified Duke (2000)
- Surgical criterion added as a new major criterion
- PCR/nucleic acid tests now count in microbiologic major criteria (not just culture)
- PET/CT promoted - abnormal activity ≥3 months post-implant = major; <3 months = minor
- Predisposition expanded - HOCM, CIED, and more valve conditions added as minor criteria
- Vascular phenomena expanded to include purulent purpura and thromboembolic phenomena
- "Probable" category removed - classification is Definite/Possible/Rejected only
Source: Textbook of Clinical Echocardiography (Table 14.1, 2023 Duke Criteria), and the 2023 Duke-ISCVID publication in Clin Infect Dis (Fowler VG et al., PMID 37138445).
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