This approach was used in a series of patients ini- tially categorized as possible IE by the original Duke criteria. Table 2. Definition of IE According to the Modified Duke Criteria* Definite IE Pathological criteria Microorganisms demonstrated by culture or histological examination of a vegetation, a vegetation that has embolized, or an intracardiac abscess specimen; or pathological lesions; vegetation or intracardiac abscess confirmed by histological examination showing active endocarditis Clinical criteria 2 Major criteria, 1 major criterion and 3 minor criteria, or 5 minor criteria Possible IE 1 Major criterion and 1 minor criterion, or 3 minor criteria Rejected Firm alternative diagnosis explaining evidence of IE; or resolution of IE syndrome with antibiotic therapy for 4 d; or no pathological evidence of IE at surgery or autopsy with antibiotic therapy for 4 d; or does not meet criteria for possible IE as above IE indicates infective endocarditis. Modifications appear in boldface. *These criteria have been universally accepted and are in current use. Reprinted from Li et al24 by permission of the Infectious Diseases Society of America. Copyright 2000, the Infectious Diseases Society of America. Baddour et al Infective Endocarditis in Adults 1439 With the guidance of the diagnostic floor, a number of these cases were reclassified as rejected for IE.24 Follow-up in these reclassified patients documented the specificity of this diagnostic schema because no patients developed IE during the subsequent 12 weeks of observation. Thus, on the basis of the weight of clinical evidence involving nearly 2000 patients in the current literature, it appears that patients suspected of having IE should be clini- cally evaluated, with the modified Duke criteria as the primary diagnostic schema. 