Duke Criteria for Infective Endocarditis

id

1731

full_title

Duke Criteria for Infective Endocarditis

short_title

Duke Criteria for IE

med_description

Diagnostic criteria for endocarditis.

description

The Duke Criteria for Infective Endocarditis provides standardized diagnostic criteria for endocarditis.

keywords

Duke Criteria for Infective Endocarditis, duke endo, duke infective, duke criteria, duke infective endo, duke endocarditis, duke infective endocarditis, endocarditis scale, endocarditis criteria, endocarditis score, endocarditis calc, diagnose endocarditis, duke diagnosis, duke endo diagnose, duke endo dx, duke endocarditis diagnose, duke endocarditis calc, duke endocarditis dx, duke rule out, duke r/o, duke endocarditis rule out, duke endocarditis r/o

complaint

[ "Fever", "Shortness of Breath" ]

formula

Selection of the appropriate criteria.

evidence

• In the original study by Durack et al, 405 consecutive cases of suspected IE in 353 patients were evaluated in a tertiary hospital from 1985 to 1992.
• Duke Criteria tried to improve on the older von Reyn criteria.
• 80% of the 69 pathologically confirmed cases were classified as clinically definite endocarditis by Duke Criteria.
• The older criteria(von Reyn) classified only 35(51%) of the 69 pathologically confirmed cases into the probable category(p<0.0001).
• 12(17%) pathologically confirmed cases were rejected by the older criteria, but none were rejected by the Duke criteria.
• Of the 150 cases rejected by older criteria, 11 were definite, 87 were probable, and 52 were rejected by the Duke Criteria.
• Duke Criteria was validated during the late 1990s with 11 major studies which included 1700 geographically and clinically diverse patient groups(adult, pediatric and geriatric patients, patients from the community, those with and without injection drug use, patients with both native and prosthetic valves, and patients treated outside of the United States).
• It showed high sensitivity(>80%) and a high negative predictive value in these studies.

measurements

[]

information

These are technically the “modified” or “revised” Duke Criteria, which were updated in 2000. The updates included:

• “Possible” IE modified to include patients having 1 major and 1 minor criterion, or 3 minor criteria.
• Nosocomially acquired Staphylococcus aureus bacteremia  also included.
• Coxiella burnetii criteria mentioned above included.
• Trans-esophageal echocardiography (TEE)  recommended for patients with prosthetic valves, rated at least “possible” by clinical criteria, or complicated IE (paravalvular abcess); Trans-thoracic echocardiography (TTE) in other patients.
• Echocardiographic minor criteria eliminated.

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/8154507", "text": "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 Mar;96(3):200-9. PubMed PMID: 8154507." } ], "Other References": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/10770721", "text": "Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, Bashore T, Corey GR. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000 Apr;30(4):633-8. Epub 2000 Apr 3. PubMed PMID: 10770721." } ], "Outcomes": [], "Validation": [], "Validations": [] }

pearls

• Formal criteria to diagnose and stratify patients suspected of having infective endocarditis (IE) into “definite”, “possible”, and “rejected”.
• Should be applied to patients in whom there is a high clinical suspicion of IE.
• Negative cultures may be confounded by a recent history of treatment with antibiotics.
• The IE Mortality Risk Score can help risk stratify patients' 6 month outcome once IE is confirmed.

usecase

Suspect IE and consider the Duke Criteria in patients with:

• Prolonged fever (Fever of Unknown Origin).
• Fever and vascular phenomena (stroke, limb ischemia, physical findings of septic emboli).
• Persistently positive blood cultures (2 or more).
• Prosthetic valves who are febrile.
• Injection drug users who are febrile.
• A pre-disposing heart condition who are febrile.
• Fever with a recent history of hospitalization.

reasons

Patients with IE can have a wide range of clinical features and the diagnosis can be challenging. This criteria is sensitive for disease detection, and has a high negative predictive value.

next_advice

The diagnosis of infective endocarditis must be made as soon as possible to initiate therapy.

“Definite”:

• Start antibiotic treatment based on guidelines and microbiology.
• Identify candidates who need surgical treatment.

“Possible”:

• Use clinical judgment to decide if the patient has IE.
• Consider trans-esophageal echocardiography (TEE), if not done.
• Identify candidates who need surgical treatment.
• Examine the patient regularly to watch for major or minor signs of IE.
• Examine for physical findings suggestive of IE (Roth’s spots, Osler's nodes, Janeway lesions.
• Draw blood cultures regularly if not positive earlier to look for microbiologic evidence.

“Rejected”:

• Consider other causes of fever, like other infectious sources, or rheumatologic or oncologic.

next_actions

• Prior treatment with even a few days of antibiotics may mask pathological evidence of IE(micro-organisms in the tissue or histological evidence).
• Consider trans-esophageal echocardiography if the clinical suspicion is high and the patient is in the “possible” group.
• Consider IE, if previously not suspected, if persistently positive (2 or more) blood cultures.
• For patients who have subacute IE and are hemodynamically stable, empiric antibiotics can be avoided so that additional blood cultures can be obtained without the confounding effect of empiric treatment.

next_management

“Definite” IE:

• One or more Pathologic criteria, or
• 2 major criteria, or
• 1 major and 3 minor criteria, or
• 5 minor criteria.

“Possible” IE:

• 1 major criterion and 1 minor criterion, or
• 3 minor criterion.

“Rejected”:

• Firm alternative diagnosis explaining evidence of IE, or
• Resolution of IE symptoms with antibiotics for less than or equal to 4 days, or
• No pathological evidence of IE at surgery or autopsy, with antibiotic therapy < 4 days, or
• Does not meet criteria of “possible”, as above.

diseases

[ "Endocarditis" ]

instructions

published

2022-04-21T20:28:59.256Z

purpose

[ "Diagnosis" ]

search_terms

[ "ie", "murmur" ]

seo

{ "keywords_en": "Duke Criteria for Infective Endocarditis, duke endo, duke infective, duke criteria, duke infective endo, duke endocarditis, duke infective endocarditis, endocarditis scale, endocarditis criteria, endocarditis score, endocarditis calc, diagnose endocarditis, duke diagnosis, duke endo diagnose, duke endo dx, duke endocarditis diagnose, duke endocarditis calc, duke endocarditis dx, duke rule out, duke r/o, duke endocarditis rule out, duke endocarditis r/o", "meta_description_en": "The Duke Criteria for Infective Endocarditis provides standardized diagnostic criteria for endocarditis." }

specialty

[ "Cardiology", "Critical Care", "Emergency Medicine", "Hospitalist Medicine", "Infectious Disease", "Internal Medicine" ]

departments

[ "Cardiac", "Hematologic", "Infectious" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 10564, "short_title_en": "2023 Duke-ISCVID Criteria", "slug": "2023-duke-international-society-cardiovascular-infectious-diseases-iscvid-criteria" }, { "calcId": 3121, "short_title_en": "IE Mortality Risk Score", "slug": "infective-endocarditis-ie-mortality-risk-score" }, { "calcId": 4027, "short_title_en": "Jones Criteria for ARF", "slug": "jones-criteria-acute-rheumatic-fever-diagnosis" } ]

ismed

true

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "cardiology", "hematology", "infectious" ]

cleaned_use

[ "Suspect IE and consider the Duke Criteria in patients with:", "Prolonged fever (Fever of Unknown Origin).", "Fever and vascular phenomena (stroke, limb ischemia, physical findings of septic emboli).", "Persistently positive blood cultures (2 or more).", "Prosthetic valves who are febrile.", "Injection drug users who are febrile.", "A pre-disposing heart condition who are febrile.", "Fever with a recent history of hospitalization." ]

pub

true