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Endocarditis: Duke

Duke Criteria for Infective Endocarditis

Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings: Duke Endocarditis Service. Am J Med. 96:200-209, 1994.

Major criteria:

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

  1. viridans streptococci, Streptococcus bovis, or HACEK group (what's this?), or
  2. community-acquired Staphylococcus aureus or enterococci, in the absence of a primary focus
  3. OR

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

    1. 2 positive cultures of blood samples drawn >12 hours apart, or
    2. all of 3 or a majority of 4 separate cultures of blood (with first and last sample drawn 1 hour apart)
    3. Positive echocardiogram for IE defined as:

      1. 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
      2. abscess, or
      3. new partial dehiscence of prosthetic valve
      4. OR

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

Minor criteria:

¹ Excludes single positive cultures for coagulase-negative staphylococci, diphtheroids, and organisms that do not commonly cause endocarditis.

Duke Clinical Criteria for Infective Endocarditis:

Clinical criteria for infective endocarditis requires:

  1. Two major criteria, or
  2. One major and three minor criteria, or
  3. Five minor criteria

References:

  1. Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. American Journal of Medicine. 96(3):200-9, 1994.

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