45. What are the Duke criteria for endocarditis?

Major criteria

Positive blood cultures
Typical organism isolated from two separate blood cultures:

  • Streptococcus viridans species or Streptococcus gallolyticus
  • HACEK group organisms
  • Staphylococcus aureus
  • Community-acquired enterococci in the absence of another focus

Persistently positive blood cultures (from organism not mentioned above).

  • Two blood cultures positive, drawn 12 hours apart
  • Three of four blood cultures positive, even if drawn together

Evidence of endocardial involvement
Echocardiographic evidence of endocarditis:

  • Vegetation defined as “oscillating intracardiac mass on a valve or supporting structure, in the path of a regurgitant jet, or on implanted material”
  • Intracardiac abscess
  • Dehiscence of a prosthetic heart valve

New valvular regurgitation (new murmur does not meet criteria).

Minor criteria

Predisposing heart condition or IV drug use

Fever (38.0 C or 100.4 F)

Vascular phenomena

  • Arterial embolism
  • Septic pulmonary infarctions
  • Mycotic aneurysm
  • Intracranial hemorrhage or conjunctival hemorrhages
  • Janeway lesions

Immunologic phenomena

  • Glomerulonephritis
  • Osler’s nodes
  • Roth spots
  • Positive rheumatoid factor

Microbiologic evidence (positive blood cultures not meeting major criteria)