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    Duke Criteria for Infective Endocarditis

    Diagnostic criteria for endocarditis.
    When to Use
    Pearls/Pitfalls
    Why Use

    Suspect IE and consider the Duke Criteria in patients with:

    • Prolonged fever (Fever of Unknown Origin)
    • Fever and vascular phenomena (stroke, limb ischemia, physical findings of septic emboli)
    • Persistently positive blood cultures (2 or more).
    • Prosthetic valves who are febrile.
    • Injection drug users who are febrile.
    • A pre-disposing heart condition who are febrile.
    • Fever with a recent history of hospitalization.
    • Formal criteria to diagnose and stratify patients suspected of having infective endocarditis (IE) into “definite”, “possible”, and “rejected”.
    • Should be applied to patients in whom there is a high clinical suspicion of IE.
    • Negative cultures may be confounded by a recent history of treatment with antibiotics.
    • The IE Mortality Risk Score can help risk stratify patients' 6 month outcome once IE is confirmed.

    Patients with IE can have a wide range of clinical features and the diagnosis can be challenging. This criteria is sensitive for disease detection, and has a high negative predictive value.

    Pathological Criteria

    If either is positive, diagnosis is definite (see Evidence for exceptions)

    Major Clinical Criteria

    If both are positive, diagnosis is definite (see Evidence for exceptions)

    Minor Clinical Criteria

    If all are positive, diagnosis is definite (see Evidence for exceptions)

    Diagnostic Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. David Durack

    About the Creator

    David Durack, MD, is an infectious disease specialist who is affiliated with Duke University Hospital and has practiced for 46 years. He received his medical degree from University of Western Australia Faculty of Medicine. Dr. Durack's clinical interests include public health, endocarditis, meningitis, septicemia, MRSA, influenza, and vaccines.

    To view Dr. David Durack's publications, visit PubMed

    Are you Dr. David Durack? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
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