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Duke Criteria for Infective Endocarditis (IE)

Major criteria:

A. Positive blood culture for Infective Endocarditis

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

  • viridans streptococci, Streptococcus bovis, or HACEK* group, or

  • community-acquired Staphylococcus aureus or enterococci, in the absence of a primary focus


2- 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)

B. Evidence of endocardial involvement

1- 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


2- 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, 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

Clinical criteria for infective endocarditis requires:

• Two major criteria, or

• One major and three minor criteria, or

• Five minor criteria

*HACEK group: Haemophilus sp, Actinobacilius actinomycetemcomitans, Cardiobacterium hominis, Eikenella rodens y Kingella sp

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