Modified Dukes Criteria for the Diagnosis of IE Definite IE

Pathologic criteria:

(1) Microorganisms demonstrated by culture or histologic examination of a vegetation that has embolized, or an intracardiac abscess specimen, or

(2) Pathologic lesions; vegetation or intracardiac abscess confirmed by histologic examination showing active endocarditis

Clinical criteria^:

(1) Two major criteria, or

(2) One major criterion and three minor criteria, or

(3) Five minor criteria Possible IE

(1) One major criterion and one minor criterion, or

(2) Three minor criteria Rejected

(1) Firm alternate diagnosis explaining evidence of IE, or

(2) Resolution of IE syndrome with antibiotic therapy for less than or equal to 4 days, or

(3) No pathologic evidence of IE at surgery or autopsy, with antibiotic therapy for less than or equal to 4 days, or

(4) Does not meet criteria for possible IE, as above

CNS, coagulase-negative staphylococci; TEE, transesophageal echocardiography; TTE, transthoracic echocardiography.

"Excludes single positive cultures for CNS and organisms that do not cause endocarditis. bSee above for definitions of major and minor criteria.

From Ref. 15, with permission. University of Chicago Press, 2000 by the Infectious Diseases Society of America. All rights reserved.

IE caused by these streptococci typically has a subacute clinical course. The current cure rate is often over 90% unless complications occur, and they do occur in

20,21

more than 30% of patients. ' The majority of viridans streptococci remain very susceptible to penicillin, with most strains having a minimum inhibitory concentration (MIC) of less than 0.125 mcg/mL.19,22 Organisms with decreased susceptibilities are increasing. Therefore, antibiotic susceptibilities need to be assessed in order to determine the most appropriate treatment regimen.

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