• Modified Duke criteria from 2000 is currently in use (Li 2000)
• Used to diagnose infective endocarditis

• IE = infective endocarditis
• TEE = transesophageal echocardiogram
• TTE = transthoracic echocardiogram

Based on the fulfillment of the pathological, major, and/or minor criteria, one of the following diagnoses can be made: (CDC Appendix B 2013,Topan 2015)

• Pathological criteria
• 2 major clinical criteria
• 1 major and 3 minor clinical criteria
• 5 minor clinical criteria

• 1 major and 1 minor clinical criteria
• 3 minor clinical criteria

• Alternative diagnosis is most probable
• Resolution of symptoms ≤ 4 days with antibiotics
• No pathologic evidence from surgery or autopsy

• Microorganism: in a culture or histology of a vegetation, embolized vegetation, or intracardiac abscess (Topan 2015)
• Pathologic lesion: active endocarditis in histology of a vegetation or intracardiac abscess

• Persistently positive blood culture
  • At least 2 sets positive > 12 hours apart or
  • At least 3 or majority of ≥ 4 sets positive for:
    • Stapylococcus aureus
    • Streptococcus bovis
    • Viridans streptococci
    • HACEK group
    • Enterococcus without a primary source

• Single positive culture:
  • Coxiella burnetii
  • Antiphase I IgG titer > 1:800

• Echocardiogram positive for IE
  • TEE in patients with prosthetic valves recommended or
  • TTE in other patients with:
    • Abscess
    • Mass on valves, supporting structures, or implanted material
    • New partial dehiscence of prosthetic valves

• New valvular reguritation

• Predisposing heart disease or condition
• Intravenous drug use

• Temperature > 100.4°F (38.0°C)

• Arterial embolism
• Septic embolism
• Conjunctival hemorrhage
• Janeway's lesion
• Mycotic aneurysm
• Intracranial hemorrhage

• Osler's node
• Roth's spot
• Glomerulonephritis
• Rheumatoid factor

• Positive blood culture without meeting the major criterion
• Excluding a single positive culture of coagulase-negative staphylococcus and organisms that do not cause endocarditis

• CDC Appendix B: U.S. Centers for Disease Control and Prevention. Appendix B: Duke Criteria for Infective Endocarditis. Morbidity and Mortality Weekly Report (MMWR) 2013;62(RR03):26. Last updated 2013-03-29 and retrieved on 2020-04-04.
• Li JS, Sexton DJ, Mick N, et al. Proposed Modifications to the Duke Criteria for the Diagnosis of Infective Endocarditis Clinical Infectious Diseases. 2000;30(4):633–638. DOI: 10.1086/313753
• Topan A, Carstina D, Slavcovici A, et al. Assesment of the Duke criteria for the diagnosis of infective endocarditis after twenty-years: An analysis of 241 cases. Clujul Med. 2015;88(3):321–326. DOI:10.15386/cjmed-469