These criteria have been well validated by comparison with surgical or autopsy findings and in the clinical outcomes of numerous studies involving a wide spectrum of patients, includ- ing children, the elderly, prosthetic valve recipients, injection drug users, and non drug users, as well as patients in both primary- and tertiary-care settings. For patients with VHD and known or suspected IE, ob- tain blood culture results before initiation of antibiotic therapy. For diagnosis and management of patients with IE, additional members of the Heart Valve MDT include infectious disease experts, who can provide advanced approaches to microbiological diagnosis. Cardiac imaging with TTE, TEE, and now CT and CT/ PET imaging is critical for diagnosis of IE.4,6 10 Recommendation-Specific Supportive Text with IE provided that 2 blood culture samples are obtained at different times, ideally >6 hours apart if clinical status allows, at peripheral sites before initiation of antimicrobial therapy. More important than the time interval of the collection of culture samples is observing strict aseptic tech- nique, avoiding sampling from intravascular lines, and ensuring an adequate volume of blood for the culture sample. Routine incubation of blood culture samples for >7 days is no longer necessary in the era of continuous-monitoring blood culture CLINICAL STATEMENTS AND GUIDELINES systems and non culture-based technology. In the 10% of patients with culture-negative endocar- ditis, serological testing or advanced laboratory diagnostics (eg, polymerase chain reaction) may be helpful to identify the etiologic agent.1,42,75 78 2. The recent onset of new or increased left-sided valve regurgitation, detected by the presence of a new or louder murmur followed by TTE confir- mation, may be attributable to endocarditis, so it is prudent to obtain blood culture samples to exclude this diagnosis. 3. 