Modified Duke’s Criteria for Infective Endocarditis : Mnemonic

Bacterial Endocarditis FIVE PM, i.e. BE FIVE PM

1. Blood culture positive for IE
2. Endocardial involvement
3. Fever
4. Immunologic phenomena
5. Vascular phenomena
6. Echocardioraphy minor criteria (eliminated)
7. Predisposition
8. Microbiologic evidence

Definite Diagnosis from Clinical Criteria:

• 2 (major) + 0 (minor) or
• 1 (major) + 3 (minor) or
• 0 (major) + 5 (minor)

Look: when major criteria decreases, subsequently minor criteria increases by odd number.

A. Major Criteria

1. Blood culture positive

a. Typical micro-organisms consistent with IE from 2 separate blood cultures – S. aureus, S. viridans, S. bovis (gallolyticus), HACEK group, Community acquired enterococci, in the absence of primary foci OR

b. Persistently positive blood culture:

• For organisms that are typical causes of IE: ≥2 positive blood cultures from blood samples drawn >12 hours apart
• For organisms that are more commonly skin contaminants: 3 or a majority of ≥4 separate blood cultures (with first and last drawn atleast 1 hour apart)

c. Single positive blood culture for Coxiella burnetii or phase I IgG antibody titre >1:800

2. Evidence of Endocardial involvement

a. Positive echocardiogram (vegetation, abscess or valve dehiscence) or

b. New valvular regurgitation (increase or change in pre-existing murmur)

B. Minor criteria

1. Fever > 38ºc
2. Immunologic phenomena (glomerulonephritis, Osler’s nodes, Roth’s spots, Rheumatoid factor)
3. Vascular phenomena (major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjuntival hemorrhage, Janeway lesions)
4. (Echocardiography minor criteria eliminated)
5. Predisposition (heart condition or IV drug user)
6. Microbiologic evidence (Positive blood culture but not meeting major criteria or serologic evidence of active infection with organism consistet with IE)

Definitive Infective Endocarditis (IE)

• Histologic evidence of active endocarditis – vegetation or intracardiac abscess OR
• Microorganism demonstrated on culture or histology of vegetation or intracardiac abscess

Clinical criteria:

• 2 Major OR
• 1 Major + 3 Minor
• 5 Minor

Possible Infective Endocarditis (IE)

1 Major + 1 Minor OR

3 Minor