Introduction

The Duke Criteria are a set of diagnostic criteria that are widely used to diagnose infective endocarditis (IE). They were first published in 1994 and have been updated several times since then. The most recent update, published in 2023, incorporates new advances in microbiology, imaging, and pathology.

This blog post will compare the updated Duke Criteria to the previous version and discuss the changes that have been made. I will also provide some relevant information that doctors need to know about the updated criteria.

Changes to the Duke Criteria

The following are the main changes that have been made to the Duke Criteria:

• New microbiology diagnostics: The updated criteria include new microbiology diagnostics, such as enzyme immunoassay for Bartonella species, polymerase chain reaction (PCR), amplicon/metagenomic sequencing, and in situ hybridization. These new tests can help to diagnose IE in patients with negative blood cultures.
• New imaging modalities: The updated criteria include new imaging modalities, such as positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) and cardiac computed tomography (CT). These imaging modalities can help to detect vegetations and other evidence of IE in patients with negative echocardiograms.
• New major clinical criterion: The updated criteria include a new major clinical criterion: intraoperative inspection. This means that a diagnosis of IE can be made based on the findings of intraoperative inspection of the heart, even if other criteria are not met.

Other relevant information

The following is some other relevant information that doctors need to know about the updated Duke Criteria:

• The updated criteria are more sensitive than the previous version, meaning that they are more likely to detect IE in patients who actually have the disease. However, this also means that the updated criteria are less specific, meaning that they are more likely to generate false-positive results.
• The updated criteria are more complex than the previous version, which can make them more difficult to use.
• The updated criteria are still under development, and it is likely that they will be revised further in the future.

Chart comparing the updated Duke Criteria to the previous version

Minor criteria

• Predisposing heart condition
• Fever of at least 38°C for at least 3 days
• Vascular phenomena
• Immunologic phenomena

Major criteria

• Positive blood culture for typical organisms from two separate blood cultures drawn at least 12 hours apart or a single positive blood culture for Coxiella burnetii or positive serological evidence of active infection with organisms consistent with IE
• Echocardiographic evidence of endocardial involvement or intraoperative inspection of the heart

Diagnosis

• Definite IE: Two major criteria or one major criterion and two minor criteria
• Possible IE: One major criterion and one minor criterion or three minor criteria

Full research paper: https://academic.oup.com/cid/article-abstract/77/4/518/7151107?redirectedFrom=fulltext&login=false