51
Table 35. Diagnosis of IE According to Proposed Modified
Duke Criteria
Pathologic criteria
• Microorganisms demonstrated by culture or histologic examination of a vegetation,
a vegetation that has embolized, or an intracardiac abscess specimen; or
• Pathologic lesions: vegetation or intracardiac abscess confirmed by histologic
examination showing active endocarditis
Clinical criteria
• 2 major criteria; or • 1 major criterion and 3 minor criteria; or • 5 minor criteria
• 1 major criterion and 1 minor criterion or • 3 minor criteria
Rejected
• Firm alternative diagnosis explaining evidence of IE; or
• Resolution of IE syndrome with antibiotic therapy for <4 d; or
• No pathologic evidence of IE at surgery or autopsy, with antibiotic therapy for <4 d; or
• Does not meet criteria for possible IE as listed above
Table 36. Modified Duke Criteria for Diagnosis of IE
1. Blood culture positive for IE
Typical microorganisms consistent with IE from 2 separate blood cultures:
• Viridans streptococci, Streptococcus bovis, HACEK group (Haemophilus spp.,
Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella spp., and
Kingella kingae), S. aureus; or community-acquired enterococci, in the absence of a
primary focus; or
Microorganisms consistent with IE from persistently positive blood cultures,
defined as follows:
• At least 2 positive cultures of blood samples drawn 12 h apart or
• All of 3 or a majority of ≥4 separate positive blood cultures (with first and last
samples drawn at least 1 h apart) or
• Single positive blood culture for Coxiella burnetii or antiphase I IgG antibody titer
>1:800
2. Evidence of endocardial involvement
• Echocardiogram positive for IE defined as follows:
▶ 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;
▶ Abscess; or
▶ New partial dehiscence of prosthetic valve
• New valvular regurgitation (worsening or changing of pre-existing murmur not sufficient)
1. Predisposition, predisposing heart condition, or injection drug use
2. Fever, temperature >38° C (100.4° F)
3. Vascular phenomena, major arterial emboli, septic pulmonary infarcts, mycotic
aneurysm, intracranial hemorrhage, conjunctival hemorrhages, and Janeway lesions
4. Immunologic phenomena: glomerulonephritis, Osler's nodes, Roth's spots, and
rheumatoid factor
5. Microbiologic evidence: positive blood culture but does not meet a major
criterion as noted above
a
or serologic evidence of active infection with organism
consistent with IE
a
Excludes single positive cultures for coagulase-negative staphylococci and organisms that do not cause IE.
Major
Criteria
Minor
Criteria
Possible
IE
Definite
IE
