Duke Criteria for Endocarditis
The Duke criteria are used to rule in or rule out endocarditis.
Endocarditis is felt to be present in the following conditions:
- Direct evidence of endocarditis based upon histological findings (a pathological criterion)
- Positive Gram stain results or cultures of specimens obtained from surgery or autopsy (a pathological criterion)
- 2 major clinical criteria
- 1 major and any 3 minor clinical criteria
- 5 minor clinical criteria
'Possible endocarditis' is defined by 1 major and 1 or 2 minor clinical criteria, OR 3 minor clinical criteria
The diagnosis of endocarditis is 'rejected' in any of the following cases:
- a firm alternate diagnosis is made
- clinical manifestations resolve after ≤4 days of antibiotic therapy
- no pathological evidence of infective endocarditis is found at surgery or autopsy after antibiotic therapy for ≤4 days
- fail to meet criteria for for possible or definite infective endocarditis
Beynon RP, Bahl VK, Prendergast BD.
Durack DT, Lukes AS, Bright DK.
Li JS, Sexton DJ, Mick N, et al.
1. Blood Culture Positive for IE?
a) Typical microorganisms consistent with IE from 2 seperate blood cultures:
i. Viridans streptococci, Streptococcus bovis, HACEK group, Staphylococcus aureus
ii. Community-acquired enterococci, in the absence of a primary focus
b) Microorganisms consistent with IE from persistently positive blood cultures, defined as follows:
i. At least 2 positive cultures of blood samples drawn >12 hours apart; or
ii. All of 3 or a majority of 4 separate cultures of blood (with first and last samples drawn at least 1 hour apart)
c) Single positive blood culture for Coxiella Burnetii or antiphase I IgG antibody titer >1:800