🦠 Infective Endocarditis Diagnosis (Modified Duke)
The modified Duke (and 2023 Duke-ISCVID) criteria classify infective endocarditis as definite, possible, or rejected using major and minor criteria.
Infective Endocarditis Diagnosis (Modified Duke)
Major · microbiology (2 sets of blood cultures with typical IE organisms / persistently positive / single C. burnetii or IgG antibody > 1:800)
Major · imaging (echo/cardiac CT showing vegetation/abscess/perivalvular involvement/new prosthetic dehiscence; or surgical/PET evidence)
Minor · predisposition (underlying heart disease/prosthetic valve/CIED/IV drug use/prior IE)
Minor · fever ≥ 38℃
Minor · vascular phenomena (arterial embolism/septic pulmonary infarction/mycotic aneurysm/intracranial hemorrhage/Janeway lesions)
Minor · immunologic phenomena (glomerulonephritis/Osler nodes/Roth spots/rheumatoid factor)
Minor · microbiologic evidence (not meeting a major criterion)
When to use
Use to combine microbiologic, imaging, and clinical findings into a diagnostic category that guides antibiotics and surgical assessment.
How it works
Definite = 2 major, or 1 major + 3 minor, or 5 minor; possible = 1 major + 1 minor, or 3 minor; otherwise rejected. Major = typical microbiology or imaging evidence; minor = predisposition, fever, vascular/immunologic phenomena, supporting microbiology.
Key points
- A negative transthoracic echo with high clinical suspicion warrants a transesophageal echo before rejecting the diagnosis (original synthesis · not guideline verbatim).
- The 2023 Duke-ISCVID revision adds cardiac CT, intraoperative findings, and PET/CT and broadens predisposition to CIED/TAVR/prior IE.
- Pathologic criteria (organism in vegetation/valve tissue) confirm directly and override the clinical count.
References
- Li JS, et al. Modified Duke criteria. Clin Infect Dis 2000.
- Fowler VG, et al. 2023 Duke-ISCVID criteria. Clin Infect Dis 2023.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.