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Duke Criteria for Infectious Endocarditis Diagnosis
Aka: Duke Criteria for Infectious Endocarditis Diagnosis, Endocarditis Diagnosis, Modified Duke Criteria for Infectious Endocarditis
- See Also
- Bacterial Endocarditis
- Criteria: Endocardititis causative organisms (used in criteria below)
- Viridans Streptococcus
- Streptococcus bovis
- Staphylococcus aureus
- Community-acquired enterococci without findings of primary focus
- Gram negative HACEK Bacilli
- Haemophilus species
- Aggregatibacter actinomycetemcomitans
- Cardiobacterium hominis
- Eikenella corrodens
- Kingella kingae
- Criteria: Major
- Positive Blood Culture
- Two separate Blood Cultures positive for causative organisms or
- Two Blood Cultures drawn >12 hours apart demonstrate causative organism or
- Blood Cultures drawn with at least 3/3 or 3/4 positive for causative organism with >1 hour between first and last blood draw or
- Single Blood Culture positive for Coxiella Burnetii or
- Phase 1 Immunoglobulin GAntibody titer >1:800
- Endocardial involvement
- New valvular regurgitation (beyond simply a change in pre-existing murmur) or
- Positive Echocardiogram
- Intracardiac abscess or
- New partial dehiscence of prosthetic valve or
- Oscillating intracardiac mass without an alternative anatomic explanation
- On valve
- On supporting structures
- In path of regugitant jets
- On implanted material
- Criteria: Minor
- Fever (>38 C or 100.4 F)
- Predisposing condition
- Heart Valve Disorder
- IV Drug Abuse
- Immunologic findings
- Glomerulonephritis
- Osler Nodes
- Roth Spots
- Rheumatoid Factor
- Microbiologic findings
- Positive Blood Culture that does not meet major criteria
- Serologic evidence of active infection with endocarditis causative organism (see above list)
- Vascular findings
- Major arterial emboli
- Septic Pulmonary Infarctions
- Mycotic aneurysm
- Intracranial Hemorrhage
- Conjunctival Hemorrhage
- Janeway Lesion
- Interpretation: Endocarditis Diagnosis
- Definitive Endocarditis Diagnosis
- Pathology specimens (microorganisms, vegetations, intracardiac abscess) from surgery or autopsy OR
- Clinical Criteria (one of the following)
- Two major criteria or
- One major criteria and three minor criteria or
- Five minor criteria
- Possible Endocarditis Diagnosis
- One major criteria and 1-2 minor criteria OR
- Three minor criteria
- Rejected Diagnosis (findings NOT consistent with Infective Endocarditis)
- Firm alternative diagnosis is established instead of Infectious Endocarditis OR
- Resolution of findings with <=4 days of antibiotic therapy OR
- No evidence of Infective Endocarditis at surgery or autopsy and <=4 days of antibiotic therapy OR
- Does not meet definitive or possible Endocarditis Diagnosis criteria (see above)
- References
- Durack (1994) Am J Med 96(3): 200-9 [PubMed]
- Li (2000) Clin Infect Dis 30(4):633-8 [PubMed]