Proposed Modifications to the Duke Criteria for the Diagnosis of Infective Endocarditis
Abstract
Although the sensitivity and specificity of the Duke criteria for the diagnosis of infective endocarditis (IE) have been validated by investigators from Europe and the United States, several shortcomings of this schema remain. The Duke IE database contains records collected prospectively on >800 cases of definite and possible IE since 1984. Databases on echocardiograms and on patients with Staphylococcus aureus bacteremia at Duke University Medical Center are also maintained. Analyses of these databases, our experience with the Duke criteria in clinical practice, and analysis of the work of others have led us to propose the following modifications of the Duke schema. The category "possible IE" should be defined as having at least 1 major criterion and 1 minor criterion or 3 minor criteria. The minor criterion "echocardiogram consistent with IE but not meeting major criterion" should be eliminated, given the widespread use of transesophageal echocardiography (TEE). Bacteremia due to S. aureus should be considered a major criterion, regardless of whether the infection is nosocomially acquired or whether a removable source of infection is present. Positive Q-fever serology should be changed to a major criterion.
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The modified Duke criteria recommend inclusion of Staphylococcus aureus bacteremia as a major criterion regardless of whether the infection is hospital acquired or community acquired.
“the modified Duke criteria (Tables 2 and 3) recommend the inclusion of S aureus bacteremia as a major criterion, regardless of whether the infection is hospital acquired (with or without a removable source of infection) or community acquired.24”
The echocardiographic minor criterion was eliminated in the modified Duke criteria.
“Therefore, this minor criterion was eliminated in the modified Duke criteria.24”
An anti-phase I immunoglobulin G antibody titer of at least 1:800 or a single blood culture positive for Coxiella burnetii should be a major criterion in the modified Duke schema.
“Thus, an anti-phase I immunoglobulin G antibody titer ≥1:800 or a single blood culture positive for C burnetii should be a major criterion in the modified Duke schema.24”
Adjustment of the Duke criteria to require a minimum of 1 major plus 1 minor criterion or 3 minor criteria as a floor to designate a case as possible infective endocarditis has been incorporated into the modified criteria to reduce the proportion of patients assigned to the possible infective endocarditis category.
“adjustment of the Duke criteria to require a minimum of 1 major plus 1 minor criterion or 3 minor criteria as a”
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- Authors
- Li, J. S., Sexton, D. J., Mick, N., Nettles, R., Fowler, V. G., Ryan, T., Bashore, T., & Corey, G. R.
- Affiliations
- Duke University (US)
- Corresponding author
- Li, J. S.
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2000-04-01
- Volume
- 30
- Issue
- 4
- Pages
- 633-638
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2156451821
- Semantic Scholar
- 3689b391ea420603f4d4eb4cea9d7918a5562986
- Cited by
- 4,027
- References
- 34
- Citations by year
- 2026: 103 · 2025: 159 · 2024: 211 · 2023: 222 · 2022: 256 · 2021: 271 · 2020: 271 · 2019: 223 · 2018: 219 · 2017: 212 · 2016: 197 · 2015: 196 · 2014: 210 · 2013: 182 · 2012: 150
- FWCI
- 24.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Streptococcal Infections and Treatments
- Keywords
- infective endocarditis, Duke criteria, Staphylococcus aureus bacteremia, transesophageal echocardiography, nosocomial infections, echocardiographic criteria
- MeSH terms
- Endocarditis, Bacterial, Humans, Databases, Factual, Echocardiography, Transesophageal
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