Key Points

1. Perform a thorough history, physical exam, routine investigations (including blood cultures), and apply the Duke criteria to establish the diagnosis of IE.

2. Certain organisms can be very difficult to culture and may give rise to "culture-negative"

IE. If these organisms are suspected, discussion and consultation with the microbiology laboratory is recommended.

3. When appropriately used, echocardiography (TTE and TEE) is extremely useful in defining both the diagnosis and prognosis of IE.

4. Categorization of patients into strata of clinical probability of disease and into strata of clinical risk for morbidity and mortality may help to determine the most appropriate timing of the echocardiographic examination and the choice of the initial echocardio-graphic modality.

5. In patients with persistent S. aureus bac-teremia or patients with prosthetic heart valves, we recommend a low threshold for echocardiography and a reduced threshold for the performance of TEE, in particular.

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