Endocarditis Diagnostic Criteria -- Modified Duke Criteria


Diagnostic: 2 Major Criteria and 0 Minor Criteria

Diagnostic: 1 Major Criteria and 3 Minor Criteria

Diagnostic: 0 Major Criteria and 5 Minor Criteria

Major Diagnostic Criteria
      Positive blood culture for typical infective endocarditis organisms (S. viridans or S. bovis, HACEK organisms, S. aureus without other primary site, Enterococcus), from 2 separate blood cultures or 2 positive cultures from samples drawn >12 hours apart, or 3 or a majority of 4 separate cultures of blood (first and last sample drawn 1 hour apart)
      Echocardiogram with 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
      Single positive blood culture for Coxiella burnetii or anti-phase 1 IgG antibody titer >1:800

Minor Diagnostic Criteria
      Predisposing heart condition or intravenous drug use
      Temp >38 degrees C (100.4 degrees F)
      Vascular phenomena: arterial emboli, pulmonary infarcts, mycotic aneurysms, intracranial bleed, 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 as noted above or serological evidence of active infection with organism consistent with endocarditis (excluding coag neg staph, and other common contaminants)




  1. Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. American Journal of Medicine. 96(3):200-9, 1994. PubMed ID: 8154507 PubMed Logo
  2. Lukes AS, Bright DK, Durack DT. Diagnosis of infective endocarditis. Infect Dis Clin North Am. 1993 Mar;7(1):1-8. Review. PubMed ID: 8463647 PubMed Logo
  3. Fournier PE, Casalta JP, Habib G, et al. Modification of the diagnostic criteria proposed by the Duke Endocarditis Service to permit improved diagnosis of Q fever endocarditis. Am J Med. 1996; 100:629. PubMed ID: 8678083 PubMed Logo
  4. Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000; 30:633. PubMed ID: 10770721 PubMed Logo



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