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Duke Criteria for Infective Endocarditis (IE)

Major criteria:

A. Positive blood culture for Infective Endocarditis

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

  • viridans streptococci, Streptococcus bovis, or HACEK* group, or

  • community-acquired Staphylococcus aureus or enterococci, in the absence of a primary focus


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

  • 2 positive cultures of blood samples drawn >12 hours apart, or

  • all of 3 or a majority of 4 separate cultures of blood (with first and last sample drawn 1 hour apart)

B. Evidence of endocardial involvement

1- Positive echocardiogram for IE defined as :

·        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

·        abscess, or

·        new partial dehiscence of prosthetic valve


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

Minor criteria:

  • Predisposition: predisposing heart condition or intravenous drug use
  • Fever: temperature > 38.0° C (100.4° F)
  • Vascular phenomena: major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, and Janeway lesions
  • Immunologic phenomena: glomerulonephritis, Osler's nodes, Roth spots, and rheumatoid factor
  • Microbiological evidence: positive blood culture but does not meet a major criterion as noted above¹ or serological evidence of active infection with organism consistent with IE
  • Echocardiographic findings: consistent with IE but do not meet a major criterion as noted above

Clinical criteria for infective endocarditis requires:

• Two major criteria, or

• One major and three minor criteria, or

• Five minor criteria

*HACEK group: Haemophilus sp, Actinobacilius actinomycetemcomitans, Cardiobacterium hominis, Eikenella rodens y Kingella sp

Related Criteria:

NYHA Functional Classification for Congestive Heart Failure

Framingham Criteria for Congestive Heart Failure

Cardiovascular Major Risk Factors

Revised Jones Criteria for Acute Rheumatic Fever (ARF)

Wells Clinical Prediction Rule for Pulmonary Embolism and Deep Venous Thrombosis

Braunwald Classification of Unstable Angina (UA)

Diagnostic Criteria for Thromboangiitis Obliterans (Buerger’s Disease)



References :

  1. Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med. 1994 Mar;96(3):200-9. [Medline]

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Created: July 14, 2005
Last Modified: 7/14/2005

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