What refinements have been made to the Duke criteria for endocarditis?
The refinements made to the Duke criteria for endocarditis include that bacteremia resulting from S aureus or enterococci is considered to fulfill a major criterion even if it is nosocomial, as several contemporary studies have documented IE in patients experiencing nosocomial staphylococcal bacteremia. Additionally, comparative effectiveness recommendations (Class I and IIa; Level of Evidence A and B only) require studies that support the use of comparator verbs to involve direct comparisons of the treatments or strategies being evaluated. Finally, data available from clinical trials or registries about the usefulness/efficacy in different subpopulations, such as sex, age, history of diabetes, history of prior myocardial infarction, history of heart failure, and prior aspirin use, has been taken into consideration. 