Infectious DiseaseCriteria

Modified Duke Criteria for Infective Endocarditis

Standard diagnostic criteria for infective endocarditis (IE) based on clinical, microbiological, and echocardiographic findings. The Modified Duke Criteria (2000 Li et al.) classify patients as Definite IE, Possible IE, or Rejected IE, guiding diagnostic workup intensity and treatment initiation.

Parameters

Major Criteria

Major #1 — Positive Blood Cultures for Typical IE OrganismsTwo SEPARATE blood cultures with: Streptococcus viridans group, Streptococcus gallolyticus (bovis), HACEK organisms (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella), Staphylococcus aureus, OR Community-acquired Enterococcus without primary focus. OR persistently positive blood cultures (any organism) from cultures drawn > 12h apart, or all 3 of ≥ 3 majority of ≥ 4 cultures positive (first and last drawn ≥ 1h apart). OR single positive blood culture for Coxiella burnetii OR anti-Phase-1 IgG titer > 1:800.Major #2 — Evidence of Endocardial InvolvementEchocardiogram positive for IE: oscillating intracardiac mass on valve or supporting structures or in path of regurgitant jets or on implanted material (vegetations); OR abscess; OR new partial dehiscence of prosthetic valve. OR new valvular regurgitation (worsening or changing of pre-existing murmur NOT sufficient).

Minor Criteria

Minor #1 — Predisposing ConditionPredisposing heart condition (known valvular heart disease, prosthetic heart valve, prior IE, congenital heart disease excluding isolated ASD, bicuspid aortic valve, hypertrophic cardiomyopathy, MVP with regurgitation) OR IV drug use.Minor #2 — Fever (Temperature > 38°C / 100.4°F)Documented fever > 38°C.Minor #3 — Vascular PhenomenaMajor arterial emboli (splenic infarct, renal infarct, limb ischemia), septic pulmonary embolism (IVDU context), mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, Janeway lesions (painless erythematous lesions on palms/soles).Minor #4 — Immunologic PhenomenaGlomerulonephritis, Osler's nodes (painful tender nodules on finger/toe pads), Roth spots (retinal hemorrhages), positive rheumatoid factor.Minor #5 — Microbiological EvidencePositive blood culture but not meeting Major criterion above (e.g., single + culture with non-typical organism) OR serological evidence of active infection with organism consistent with IE.

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