infectious-disease cardiology

Duke Criteria for Infective Endocarditis

Diagnoses infective endocarditis using major and minor Duke criteria. Guides echocardiography, blood culture interpretation, and empirical antibiotic selection.

Major: positive blood cultures — typical organisms in 2 separate cultures, persistently positive cultures (≥ 2 drawn > 12 h apart, or all 3 / most of ≥ 4), or Coxiella burnetii (single culture or phase I IgG > 1:800)*

Major criterion: Positive echocardiogram (oscillating intracardiac mass, abscess, partial prosthetic dehiscence, new valve regurgitation)*

Minor: predisposition — predisposing heart condition or injection drug use*

Minor: fever ≥ 38 °C*

Minor: vascular phenomena — major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial or conjunctival haemorrhage, Janeway lesions*

Minor: immunological phenomena — glomerulonephritis, Osler nodes, Roth spots, rheumatoid factor*

Minor: microbiological evidence — positive blood culture not meeting a major criterion, or serological evidence of active infection with an organism consistent with IE*

Pathological criteria: microorganisms on culture or histology of a vegetation, embolised vegetation or intracardiac abscess, or active endocarditis on histology (definite IE on its own)

Yes

Score interpretation

Definite Infective Endocarditis 2

Meets the modified Duke definite criteria.

→ Treat as IE: endocarditis team (infection, cardiology, cardiac surgery); antibiotics per guideline.

Possible Infective Endocarditis 1

Meets the modified Duke possible criteria.

→ Further blood cultures and imaging (TOE if TTE is negative or a prosthetic valve is present); endocarditis team review.

IE Criteria Not Met 0

Does not meet the definite or possible criteria.

→ Consider alternative diagnoses; reassess if new findings, blood cultures or imaging become available.

Interpretation bands for the Duke Criteria IE. Apply clinical judgement and local guidance.

References

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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