TABLEII.
DefinitionsofTermsUsedintheDukeCriteriafor theDiagnosisofInfectiveEndocarditis
Majorcriteria
(1) Positivebloodculture forIE
A. Typicalmicroorganism consistentwith IEfrom2separateblood culturesasnotedbelow:
(i) Viridansstreptococci,* Streptococcusbovis,orHACEKgroupor
(ii) Community-acquiredStaphylococcusaureusorenterococci,intheabsenceofa
primaryfocusor
B. MicroorganismsconsistentwithIEfrompersistentlypositiveblood culturesdefinedas
(i) >2positiveculturesofbloodsamplesdrawn>12hapartor
(ii) Allof3oramajorityof>4separateculturesofblood(withfirstandlastsample
drawn>1hapart)
(2) Evidenceofendocardialinvolvement
A. PositiveechocardiogramforIEdefinedas
(i) Oscillatingintracardiac massonvalveorsupportingstructures, inthepathof
regurgitantjets,oronimplantedmaterialintheabsenceofanalternativeanatomic
explanation,or
(ii) Abscess,or
(iii) Newpartialdehiscenceofprostheticvalveor
B. Newvalvularregurgitation(worseningorchangingofpreexistingmurmurnotsufficient)
Minorcriteria
(1) Predisposition:predisposingheartcondition orIVdruguse
(2) Fever:temperature 38.0°C
(3)Vascularphenomena:majorarterialemboli,septicpulmonaryinfarcts,mycoticaneurysm,
intracranialhemorrhage,conjunctival hemorrhages,andJanewaylesions
(4) Immunologicphenomena:glomerulonephritis, Oslernodes,Roth spots,andrheumatoidfactor
(5)Microbiologicalevidence:positivebloodculturebutdoesnotmeetamajorcriterionasnoted
aboveorserologicalevidenceofactive infectionwithorganismconsistentwithIE
(6)Echocardiographicfindings:consistentwithIEbutdonotmeetamajorcriterion asnotedabove
HACEKindicatesHaemophilusspecies,Actinobacillus(Haemophilis)actino- mycetemcomitans, Cardiobacterium hominis, Eikenellaspecies,andKingellakingae
IE = infective endocarditis; IV = intravenous
*Includesnutritionally variantstrains(Abiotrophiaspecies).
†Excludessinglepositiveculturesforcoagulase-negativestaphylococciand organismsthatdonot
causeendocarditis.
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;96:200-9. Used by permission.