Duke Criteria

Other Known Aliases – none

Definition – radiographic, laboratory, pathologic, and clinical criteria to help establish the diagnosis of infective endocarditis and (similar to the Jones Criteria) there are major and minor subtypes:

• Major
  • Two positive blood cultures (drawn 12 hours apart) with typical endocarditis pathogen
    • Viridans-group streptococci
    • Streptococcus bovis
    • HACEK group
    • Staphylococcus aureus
    • Community-acquired enterococci
    • Coxiella burnetii
  • Evidence of endocardial involvement with positive echocardiogram showing:
    • oscillating intracardiac mass
    • Abscess
    • partial dehiscence of prosthetic valve or new valvular regurgitation
• Minor
  • known cardiac lesion or IVDU
  • Fever > 38°C
  • Evidence of septic emboli
  • Immunologic phenomenon: glomerulonephritis, Osler’s nodes, Janeway lesions, conjunctival hemorrhage
  • Positive blood culture  or laboratory evidence of organisms not described above

Clinical Significance – a diagnosis of infective endocarditis is made with 1 major and 1 minor, or 3 minor criteria

History – Named after the Duke Endocarditis Service, which established these criteria with their seminal paper entitled “New Criteria for the diagnosis of infective endocarditis” in 1994.  The group sought to improve upon the older von Reyn criteria and increase the specificity, so as to not miss cases and have potentially catastrophic cardiac complications later.  These criteria were further validated several times throughout the 1990s and modified in 2000, which is the current set we use today.

References

1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
5. Up To Date. www.uptodate.com
6. 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; 96(3):200-9. [pubmed]
7. Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2000; 30(4):633-8. [pubmed]