Definition of Terms Used in the Proposed Modified Duke Criteria

Major criteria
    Blood culture positive for IE
        Typical microorganisms consistent with IE from 2 separate blood cultures:
            Viridians streptococci, Streptococcus bovis, HACEK group (Haemophilus species [H parainfluenzae, H aphrophilus, and H paraphrophilus), Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella species), S aureus;
            Community-acquired enterococci, in the absence of a primary focus; or
            Microorganisms consistent with IE from persistently positive blood cultures, defined as:
                At least 2 positive cultures of blood samples drawn >12 h apart; or
                All of 3 or a majority of ≥4 separate cultures of blood (with first and last sample drawn at least 1 h apart)
        Single positive blood culture for Coxiella burnetii or antiphase I IgG antibody titer >1:800
        Evidence of endocardial involvement
        Echocardiogram positive for IE (TEE recommended in patients with prosthetic valves, rated at least ‘possible IE’ by clinical criteria, or complicated IE [paravalvular abscess]; TTE as first test in other patients), defined as follows:
            Oscillating intracardiac mass on valve or supporting structures, in the path of regurgitant jets, or on implanted material in the absence of an alternative anatomic explanation;
            Abscess; or
            New partial dehiscence of prosthetic valve; or
            New valvular regurgitation (worsening or changing of pre-existing murmur not sufficient)
Minor criteria
    Predisposition, predisposing heart condition, or injection drug use
    Fever, temperature >38°C
    Vascular phenomena, major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, and Janeway's lesions
    Immunologic phenomena: glomerulonephritis, Osler's nodes, Roth's spots, and rheumatoid factor
    Microbiological evidence: positive blood culture, but does not meet a major criterion as noted above or serological evidence of active infection with organism consistent with IE