There is no evidence for IE prophylaxis in gastrointestinal procedures or genitourinary procedures, in the absence of known active infection. Recommendation-Specific Supportive Text 1. The risk of developing IE is highest in patients with a prosthetic valve, prior IE, or congenital heart dis- ease with residual flow disturbances.3 IE has been reported to occur after transcatheter aortic valve implantation (TAVI) at rates equal to or exceeding those associated with surgical aortic valve replace- ment (SAVR) and is associated with a high 1-year mortality rate of 75%.23,24 IE may also occur after valve repair with prosthetic material, which results in high in-hospital and 1-year mortality rates, even with surgical intervention.25,26 IE appears to be more common in heart transplant recipients than in the general population, according to lim- The risk of IE is highest in the first 6 months after transplantation because of endothe- lial disruption, high-intensity immunosuppressive therapy, frequent central venous catheter access, and frequent endomyocardial biopsies.3 Persons at risk of IE can reduce potential sources of bac- terial seeding by maintaining optimal oral health through regular professional dental care and the use of appropriate dental products, such as man- ual, powered, and ultrasonic toothbrushes; dental floss; and other plaque-removal devices. 2. Transient bacteremia is commonly seen in rou- tine activities such as brushing teeth and floss- ing (20% to 68%), using toothpicks (20% to 40%), and simply chewing food (7% to 51%). The incidence of IE after most procedures is low, with no controlled data supporting the benefit of antibiotic prophylaxis. Indiscriminate use of anti- biotics can be associated with the development of resistant organisms, Clostridium difficile colitis, unnecessary expense, and drug toxicity. 