Patients selected for OPAT should be at low risk for the complications of IE, the most frequent of which are heart failure and systemic emboli. The period of greatest risk for systemic emboli is before or within the first 1 to 2 weeks of antimicrobial therapy, although serious complications such as heart failure and rupture of MAs may develop weeks to months after the initiation of antimicro- bial therapy. The presence of poorly controlled heart failure, neurological findings that may result from systemic emboli or bleeding MAs, cardiac conduction abnormalities, valve ring abscesses (usually detected by TEE), persistent fever, or persis- tently positive blood cultures should preclude OPAT. The risk for drug-related side effects usually increases with a prolonged drug exposure (eg, vestibular, auditory, and nephrotoxicity resulting from aminoglycosides; leukopenia caused by -lactams and vancomycin; and nephrotoxicity resulting from the combination of vancomycin and gentami- cin) and requires close monitoring by the home infusion team consisting of representatives from nursing and pharmacy and clinicians with expertise in IE management. The following criteria are essential for an effective OPAT program: A reliable support system at home and easy access to a hospital for prompt re-evaluation by an experienced clinician if a complication such as recurrence of fever, symptoms of a cardiac arrhythmia, heart failure, or a neurological event develops Regular visits by a home infusion nurse who carefully monitors the patient for early detection of complications, failure to respond to therapy, problems with adherence to therapy, or complications (eg, catheter-related infection, catheter leakage or displacement, venous thrombosis) directly related to the antibiotics or intravenous access Regular visits with an experienced clinician to assess clinical status during the OPAT Recommendations 1. 