Duke Criteria for Infective Endocarditis

Diagnostic criteria for endocarditis.

Pathological Criteria

Microorganisms in a vegetation

  • Demonstrated by culture or histologic examination of a vegetation, a vegetation that has embolized, or an intracardiac abscess specimen

Pathologic Lesions

  • Vegetation or intracardiac abscess confirmed by histologic examination showing active endocarditis

Major Clinical Criteria

Blood cultures positive for endocarditis

  • Typical microorganisms consistent with IE from 2 separate blood cultures?
  • Microorganisms consistent with IE from persistently positive blood cultures?
  • Single positive blood culture for Coxiella burnetii or antiphase I IgG antibody titer >1:800

Evidence of endocardial involvement

  • Echocardiogram positive for IE
  • Abscess
  • New partial dehiscence of prosthetic valve
  • New valvular regurgitation
  • Note: Worsening or changing of pre-existing murmur NOT sufficient

Minor Clinical Criteria

Predisposing heart condition or injection drug use


Vascular phenomena

  • Major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, and Janeway’s lesions

Immunologic phenomena

  • Glomerulonephritis, Osler's nodes, Roth's spots, and rheumatoid factor

Microbiological evidence

  • Positive blood culture but does not meet a major criterion as noted above or serological evidence of active infection with organism consistent with IE


Source: Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med. 1994 Mar;96(3):200-9. PubMed PMID: 8154507.