Diagnosis of IE Recommendations for Diagnosis of IE Referenced studies that support the recommendations are summarized in Online Data Supplement 42. COR LOE Recommendations In patients at risk of IE (eg, those with congenital or acquired VHD, previous IE, prosthetic heart valves, certain congenital or heritable heart malformations, immunodeficiency states, or injection drug use) who have unexplained fever blood, culture samples should be obtained.1 In patients with the recent onset of left-sided valve regurgitation, at least 2 sets of blood culture samples should be obtained.1 12 In patients with suspected IE, the Modified Duke Criteria should be used for diagnosis Patients with IE should be evaluated and managed with consultation with a multispecialty Heart Valve Team, which includes an infectious disease specialist, cardiologist, and cardiac surgeon; a cardiac anesthesiologist for surgically managed ; and a neurologist for patients with In patients with suspected IE, TTE is recommended to identify vegetations, characterize the hemodynamic severity of valvular lesions, assess ventricular function and pulmonary pressures, and detect In all patients with known or suspected IE and nondiagnostic TTE results, when complications have developed or are clinically suspected or when intracardiac device leads are present, TEE is recommended.21,23 40 In patients with IE who have a change in clinical signs or symptoms (eg, new murmur, embolism, persistent fever, HF, abscess, or atrioventricular heart block) and in patients at high risk of complications (eg, extensive infected tissue, large vegetation on initial echocardiogram, or staphylococcal, enterococcal, or fungal infections), TTE and/or TEE are recommended for In patients undergoing valve surgery for IE, intraoperative TEE is recommended.47 50 In patients being considered for an early change to oral antibiotic therapy for the treatment of stable IE, a baseline TEE before switching to oral therapy and a repeat TEE 1 to 3 days before completion of the oral antibiotic regimen should be performed.51 In patients with Staphylococcus aureus bacteremia without a known source, TEE is reasonable to diagnose possible IE.11,36,52 56 In patients with a prosthetic valve in the presence of persistent fever without bacteremia or a new murmur, a TEE is reasonable to aid in the diagnosis of IE.57 60 In patients in whom the anatomy cannot be clearly delineated by echocardiography in the setting of suspected paravalvular infections, CT imaging is reasonable.37,61 68 In patients classified by Modified Duke Criteria as having possible IE, F-fluorodeoxyglucose PET/CT is reasonable as adjunct diagnostic imaging.69 71 In patients with nosocomial S. aureus bacteremia with a known portal of entry from an extracardiac source, TEE might be considered to detect concomitant Synopsis In patients with suspected endocarditis, the Modified Duke Criteria (Tables 24 and 25) are the current stan- dard for diagnosis and incorporate clinical, imaging, and bacteriological criteria. 