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Duke Criteria for Infective Endocarditis

Diagnostic criteria for endocarditis.

Pathological Criteria
Major Clinical Criteria
Minor Clinical Criteria
About the Creator
David Durack
Dr. David Durack
Content Contributors
  • Pranay Aryal, MD

Advice

The diagnosis of infective endocarditis must be made as soon as possible to initiate therapy.

“Definite”:

  • Start antibiotic treatment based on guidelines and microbiology.
  • Identify candidates who need surgical treatment.

“Possible”:

  • Use clinical judgment to decide if the patient has IE.
  • Consider trans-esophageal echocardiography (TEE), if not done.
  • Identify candidates who need surgical treatment.
  • Examine the patient regularly to watch for major or minor signs of IE.
  • Examine for physical findings suggestive of IE (Roth’s spots, Osler's nodes, Janeway lesions
  • Draw blood cultures regularly if not positive earlier to look for microbiologic evidence.

“Rejected”:

  • Consider other causes of fever, like other infectious sources, or rheumatologic or oncologic.

Management

“Definite” IE:

  • One or more Pathologic criteria, or
  • 2 major criteria, or
  • 1 major and 3 minor criteria, or
  • 5 minor criteria

“Possible” IE:

  • 1 major criterion and 1 minor criterion, or
  • 3 minor criterion

“Rejected”:

  • Firm alternative diagnosis explaining evidence of IE, or
  • Resolution of IE symptoms with antibiotics for less than or equal to 4 days, or
  • No pathological evidence of IE at surgery or autopsy, with antibiotic therapy < 4 days, or
  • Does not meet criteria of “possible”, as above.

Critical Actions

  • Prior treatment with even a few days of antibiotics may mask pathological evidence of IE(micro-organisms in the tissue or histological evidence).
  • Consider trans-esophageal echocardiography if the clinical suspicion is high and the patient is in the “possible” group.
  • Consider IE, if previously not suspected, if persistently positive (2 or more) blood cultures.
  • For patients who have subacute IE and are hemodynamically stable, empiric antibiotics can be avoided so that additional blood cultures can be obtained without the confounding effect of empiric treatment.
Content Contributors
  • Pranay Aryal, MD