Patients with suspected IE are most optimally managed in an environment that coordinates the management of specialists who are well attuned to the various organ systems, pathological processes, and potential treatment Table 24. Diagnosis of IE According to the Proposed 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; or 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 listed above IE indicates infective endocarditis. Adapted from Durack DT, et al,2 and Li JS, et al.4 Table 25. 