Duke Criteria

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Diagnostic criteria for Infectious Endocarditis originally proposed in 1994[1]. Based on combination of echo, laboratory, and physical examination findings.


Major criteria:

  • Bacteremia with typical organisms
  • 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
  • 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)
  • Echocardiographic findings
  • Vegetations
  • Abscesses
  • Valve dehiscence – prosthetic valves
  • New valvular regurgitation
  • Echocardiography has become the major mode of diagnosis, especially if blood cultures are negative.

Minor Criteria:

  • Predisposing condition, IVDA
  • Fever > 38
  • Vascular phenomena
  • Arterial embolism
  • Septic pulmonary infarcts
  • Mycotic aneurysm
  • Intracranial hemorrhage
  • Janeway lesions
  • Immunologic phenomena
  • Glomerulonephritis
  • Osler nodes
  • Roth spots
  • 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


  1. Durack DT, Lukes AS, Bright DK. Am J Med 96:200-209, 1994.
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