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Duke Endocarditis Service Criteria

Major Criteria

Positive Blood Culture for Infective Endocarditis

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

  • viridans streptococci, Streptococcus bovis, or HACEK group (what's this?), or
  • community-acquired Staphylococcus aureus or enterococci, in the absence of a primary focus

or

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)

Evidence of Endocardial Involvement

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
or


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 (what's this?), 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

¹Excludes single positive cultures for coagulase-negative staphylococci, diphtheroids, and organisms that do not commonly cause endocarditis.

Duke Clinical Criteria for Infective Endocarditis:
Clinical criteria for infective endocarditis requires: