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Duke Criteria (Endocarditis)

Duke Criteria (Endocarditis)

Standardized diagnostic tool for confirming or ruling out infective endocarditis

Duke Criteria (Endocarditis)

Duke Criteria (Endocarditis)

Standardized diagnostic tool for confirming or ruling out infective endocarditis

Major Criteria
Blood culture positive for IE
Typical microorganisms consistent with IE from 2 separate blood cultures, or persistently positive blood cultures
Evidence of endocardial involvement
Echocardiogram positive for IE or new valvular regurgitation
Minor Criteria
Predisposition
Predisposing heart condition or injection drug use
Fever
Temperature ≥ 38.0°C (100.4°F)
Vascular phenomena
Major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, Janeway lesions
Immunologic phenomena
Glomerulonephritis, Osler nodes, Roth spots, rheumatoid factor
Microbiological evidence
Positive blood culture but does not meet a major criterion or serological evidence of active infection with organism consistent with IE
Pathological Criteria
Microorganisms demonstrated by culture or histologic examination
of a vegetation, a vegetation that has embolized, or an intracardiac abscess specimen
Pathologic lesions
vegetation or intracardiac abscess confirmed by histologic examination showing active endocarditis
Duke Criteria: Rejected
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Instructions

The Duke Criteria are used to help diagnose infective endocarditis (IE) by combining clinical, microbiological, and echocardiographic findings. It categorizes cases as definite, possible, or rejected endocarditis, guiding diagnosis and management.

Overview
When to use
Why use
Evidences

The Duke Criteria diagnose infective endocarditis (IE) using weighted major/minor clinical, microbiologic, and imaging findings; the 2000 modified Duke criteria remain widely known, and a 2023 Duke‑ISCVID update expanded typical pathogens, added PET/CT and cardiac CT as major imaging criteria, and refined microbiology rules, improving sensitivity without sacrificing specificity in external validation.
https://academic.oup.com/cid/article-abstract/30/4/633/419335?redirectedFrom=fulltext&login=false

Diagnosis is classified as definite, possible, or rejected based on combinations of major and minor criteria; pathologic proof is definitive, while clinical “definite” can be made with 2 major, 1 major + 3 minor, or 5 minor criteria. Typical IE pathogens in blood cultures or persistently positive cultures, and evidence of endocardial involvement by echocardiography (vegetation, abscess, prosthetic dehiscence) or new valvular regurgitation.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4632890/

PET/CT with 18F‑FDG and cardiac CT count as major imaging criteria, and intraoperative inspection is recognized as a major clinical criterion; modern microbiologic methods (PCR, metagenomic sequencing, in situ hybridization) incorporated. Expanded and contextualized “typical” organisms, including some considered typical only with intracardiac prostheses; clarified predisposing conditions such as TAVI valves, CIEDs, and prior IE.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10681650/

In 595 suspected IE cases, the 2023 Duke‑ISCVID criteria were more sensitive than modified Duke and 2015 ESC criteria (84.2% vs 74.9% and 80%) with no loss of specificity, and more specific than 2023 ESC criteria at similar sensitivity; gains were driven by revised major microbiologic and imaging criteria.
https://pubmed.ncbi.nlm.nih.gov/38330166/

Incorporating 18F‑FDG PET/CT improves sensitivity for prosthetic valve IE vs modified Duke alone, though with trade‑offs in specificity and operational variability; these insights informed both ESC 2015 and Duke‑ISCVID 2023 updates.
https://www.acc.org/latest-in-cardiology/journal-scans/2020/12/08/19/52/comparison-between-esc-and-duke-criteria

Overview
When to use
Why use
Evidences

The Duke Criteria were developed to provide a structured and reliable framework for diagnosing infective endocarditis, a potentially life-threatening infection of the heart valves or endocardial surface. Endocarditis can present with vague and nonspecific symptoms such as fever, malaise, or weight loss, which makes diagnosis challenging. However, untreated cases carry high morbidity and mortality, emphasizing the need for accurate and timely identification.

The criteria combine major and minor clinical findings into a system that helps clinicians categorize the likelihood of infective endocarditis. Major criteria include findings such as positive blood cultures with typical microorganisms and evidence of endocardial involvement (usually via echocardiography). Minor criteria include predisposing heart conditions, fever, vascular phenomena (like emboli or Janeway lesions), immunological phenomena (like Osler nodes), and microbiological evidence not meeting major criteria.

A diagnosis is established as “definite,” “possible,” or “rejected” depending on the number and combination of these criteria. The Duke Criteria are widely adopted due to their balance of sensitivity and specificity, although they are not perfect. For example, culture-negative endocarditis or early disease may not meet full criteria, and imaging limitations may affect interpretation.

Overview
When to use
Why use
Evidences

The Duke Criteria diagnose infective endocarditis (IE) using weighted major/minor clinical, microbiologic, and imaging findings; the 2000 modified Duke criteria remain widely known, and a 2023 Duke‑ISCVID update expanded typical pathogens, added PET/CT and cardiac CT as major imaging criteria, and refined microbiology rules, improving sensitivity without sacrificing specificity in external validation.
https://academic.oup.com/cid/article-abstract/30/4/633/419335?redirectedFrom=fulltext&login=false

Diagnosis is classified as definite, possible, or rejected based on combinations of major and minor criteria; pathologic proof is definitive, while clinical “definite” can be made with 2 major, 1 major + 3 minor, or 5 minor criteria. Typical IE pathogens in blood cultures or persistently positive cultures, and evidence of endocardial involvement by echocardiography (vegetation, abscess, prosthetic dehiscence) or new valvular regurgitation.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4632890/

PET/CT with 18F‑FDG and cardiac CT count as major imaging criteria, and intraoperative inspection is recognized as a major clinical criterion; modern microbiologic methods (PCR, metagenomic sequencing, in situ hybridization) incorporated. Expanded and contextualized “typical” organisms, including some considered typical only with intracardiac prostheses; clarified predisposing conditions such as TAVI valves, CIEDs, and prior IE.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10681650/

In 595 suspected IE cases, the 2023 Duke‑ISCVID criteria were more sensitive than modified Duke and 2015 ESC criteria (84.2% vs 74.9% and 80%) with no loss of specificity, and more specific than 2023 ESC criteria at similar sensitivity; gains were driven by revised major microbiologic and imaging criteria.
https://pubmed.ncbi.nlm.nih.gov/38330166/

Incorporating 18F‑FDG PET/CT improves sensitivity for prosthetic valve IE vs modified Duke alone, though with trade‑offs in specificity and operational variability; these insights informed both ESC 2015 and Duke‑ISCVID 2023 updates.
https://www.acc.org/latest-in-cardiology/journal-scans/2020/12/08/19/52/comparison-between-esc-and-duke-criteria

Frequently Asked Questions

Features and Services FAQs

Discover the full range of features and services we offer and how to use them.

Can Duke Criteria be used alone to diagnose endocarditis?+
How accurate are the Duke Criteria?+
Why are echocardiographic findings part of the major criteria?+
Can they be used in prosthetic valve endocarditis?+
What happens if the criteria suggest “possible endocarditis”?+
Do the criteria apply in children?+

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