Correct! OPAT should be considered in patients with left-sided IE caused by Streptococcus spp., E. faecalis, S. aureus, or Coagulase-negative staphylococci who were receiving appropriate i.v. antibiotic treatment for at least 10 days, are clinically stable and who do not show signs of abscess formation or valve abnormalities requiring surgery on TOE. (Class IIa Level A.)

Correct! OPAT should be considered in patients with left-sided IE caused by Streptococcus spp., E. faecalis, S. aureus, or Coagulase-negative staphylococci who were receiving appropriate i.v. antibiotic treatment for at least 10 days (or at least 7 days after cardiac surgery), are clinically stable, and who do not show signs of abscess formation or valve abnormalities requiring surgery on TOE. (Class IIa, Level A.)

Incorrect. OPAT is not recommended in patients with IE caused by highly difficult-to-treat microorganisms (Candida spp., MRSA, VRE), liver cirrhosis (Child– Pugh B or C), severe cerebral nervous system emboli, untreated large extracardiac abscesses, heart valve complications, or other severe conditions requiring surgery, severe post-surgical complications, and in people who inject drugs (PWID)-related IE. (Class III, Level C.)

Incorrect. OPAT is not recommended in patients with IE caused by highly difficult-to-treat microorganisms, liver cirrhosis (Child–Pugh B or C), severe cerebral nervous system emboli, untreated large extracardiac abscesses, heart valve complications, or other severe conditions requiring surgery, severe post-surgical complications, and in people who inject drugs (PWID)-related IE. (Class III, Level C.)

Correct! Cardiac CT is more accurate than transoesophageal echocardiography (TOE) for diagnosing perivalvular and periprosthetic complications of IE (abscesses, pseudoaneurysms, and fistulae) and is recommended in both native valve endocarditis and prosthetic valve endocarditis if TOE is not conclusive or not feasible.

Correct. This is the indication for CT and magnetic resonance imaging (MRI). MRI has higher sensitivity than CT for the diagnosis of neurological lesions and, hence, increases the likelihood of detecting neurological complications in patients with IE. Patients with IE might present CNS lesions in up to 60–80 % of cases, most of them corresponding to ischaemic lesions (50–80 % of patients) that are often small and asymptomatic and do not impact on the decision-making.

Correct! Cardiac CT is a valuable alternative for non-invasive assessment of coronary artery disease before cardiac surgery in patients with IE.

Correct! Whole-body and brain CT are useful for assessing IE systemic complications, including septic emboli. The detection of distant lesions adds a minor diagnostic criterion leading to a more conclusive diagnosis of definite or rejected IE, and can be relevant for decision-making.

Correct! Nevertheless, the role of cardiac MRI to diagnose IE is limited by the low spatial resolution (as compared with cardiac CT) and the signal void generated by some prostheses impairing the assessment of prosthetic valve anatomy and function.

Correct! MRI has higher sensitivity than computed tomography (CT) for the diagnosis of neurological lesions and, hence, increases the likelihood of detecting neurological complications in patients with IE. Patients with IE might present CNS lesions in up to 60–80 % of cases, most of them corresponding to ischaemic lesions (50–80% of patients) that are often small and asymptomatic and do not impact on the decision-making.

Correct! MRI is the diagnostic modality of choice of spondylodiscitis and vertebral osteomyelitis with a diagnostic accuracy of 89–94%. MRI findings include vertebrae and disc oedema, paravertebral/epidural inflammation or abscess, bone erosion, and gadolinium enhancement of vertebrae and discs.

Correct. Both MRA or computed tomography angiography (CTA) can detect mycotic arterial aneurysms complicating IE.

Correct! (Class I, Level B.)

Correct! (Class I, Level B.)

Incorrect. WBC SPECT/CT should be considered in patients with high clinical suspicion of PVE when echocardiography is negative or inconclusive and when PET/CT is unavailable. (Class IIa, Level C.)

Incorrect. Brain and whole-body imaging (CT, [18F]FDG-PET/CT, and MRI) in NVE and PVE are recommended for screening of peripheral lesions in symptomatic patients to detect peripheral lesions or add minor diagnostic criteria (Class I, Level B) and may be considered for screening of peripheral lesions in asymptomatic patients. (Class IIb, Level B.)

Correct! This is a minor criterion. Immunological phenomena include glomerulonephritis, Osler nodes and Roth spots, and rheumatoid factor.

Correct! This is a minor criterion.

Correct! This is a minor criterion.Embolic vascular dissemination (including those asymptomatic detected by imaging only) include: • Major systemic and pulmonary emboli/infarcts and abscesses.• Haematogenous osteoarticular septic complications (i.e. spondylodiscitis).• Mycotic aneurysms.• Intracranial ischaemic/haemorrhagic lesions.• Conjunctival haemorrhages.• Janeway’s lesions.

Incorrect. This is a major criterion.

Incorrect. This is needed for classification of Definite IE.

Incorrect. This is needed for classification of Definite IE.

Correct!

Correct!

Correct!

Incorrect. This is needed for classification of Possible IE.

Incorrect. This is needed for classification of Possible IE.

Correct!

Correct! (Class I, Level B)

Incorrect. In this case EMERGENCY (within 24 h.) surgery is recommended. (Class I, Level B.)

Incorrect. In this case urgent surgery MAY BE CONSIDERED. (Class IIb, Level B.)

Correct! (Class I, Level B.)

Incorrect! Uncontrolled infection can be present in the form of persistent infection when blood cultures remain positive for >1 week or persistent sepsis despite appropriate antimicrobial therapy.

Correct! Uncontrolled infection can be present in the form of persistent infection when blood cultures remain positive for >1 week or persistent sepsis despite appropriate antimicrobial therapy.

Correct! Abscess formation can be a sign of locally uncontrolled infection.

Correct! New atrioventricular block (AVB) can be a sign of locally uncontrolled infection.

Correct! (Class I, Level B.)

Incorrect. In embolic stroke, mechanical thrombectomy may be considered if the expertise is available in a timely manner. (Class IIb, Level C.)

Incorrect. Thrombolytic therapy is not recommended in embolic stroke due to IE. (Level III, Class C.)

Incorrect. If non-invasive techniques are negative and the suspicion of infective aneurysm remains, invasive angiography should be considered. (Class IIa, Level B.)

Correct! MRI or PET/CT is recommended in patient with suspected spondylodiscitis and vertebral osteomyelitis complicating IE. (Class I, Level C.)

Correct! More than 6-week antibiotic therapy should be considered in patients with osteoarticular IE-related lesions caused by difficult-to-treat microorganisms, such as S. aureus or Candida spp., and/or complicated with severe vertebral destruction or abscesses. (Class IIa, Level C.)

Incorrect.Transthoracic echocardiography (TTE)/Transoesophageal echocardiography (TOE) is recommended to rule out IE in patients with spondylodiscitis and/or septic arthritis with positive blood cultures for typical IE microorganisms. (Class I, Level C.)

Correct! Transthoracic echocardiography (TTE)/Transoesophageal echocardiography (TOE) is recommended to rule out IE in patients with spondylodiscitis and/or septic arthritis with positive blood cultures for typical IE microorganisms. (Class I, Level C.)

Correct! Antibiotic prophylaxis is recommended in patients with previous IE. (Class I, Level B.)

Correct! Antibiotic prophylaxis is recommended in patients with surgically implanted prosthetic valves and with any material used for surgical cardiac valve repair. (Class I, Level C.)

Correct! Antibiotic prophylaxis is recommended in patients with transcatheter implanted aortic and pulmonary valvular prostheses. (Class I, Level C.)

Incorrect. Bicuspid aortic valve, rheumatic or degenerative valvular disease, hypertrophic cardiomyopathy or cardiac implantable devices belong to moderate risk group for IE development, hence routine ATB therapy is not recommended. (Class III, Level C)

Correct! Moreover, addiction treatment for patients following PWID-related IE is recommended. (Class I, Level C.)

Incorrect. According to the following study by Iversen K et al., in patients with left-side infective endocarditis who were in stable condition, changing to oral antibiotic treatment was non-inferior to continued intravenous antibiotic treatment.“Iversen K, Ihlemann N, Gill SU, Madsen T, Elming H, Jensen KT, et al. Partial oral versus intravenous antibiotic treatment of endocarditis. N Engl J Med 2019;380:415–424. https://doi.org/10.1056/NEJMoa1808312”

Incorrect. According to the following study, residual vegetation after treatment for IE did not show increased risk of recurrence of IE. Although the results should be interpreted with caution.“Ostergaard L, Dahl A, Fosbol E, Bruun NE, Oestergaard LB, Lauridsen TK, et al. Residual vegetation after treatment for left-sided infective endocarditis and subsequent risk of stroke and recurrence of endocarditis. Int J Cardiol 2019;293:67–72. https://doi.org/10.1016/j.ijcard.2019.06.059”

Correct! Patients should be educated about the risk of recurrence and preventive measures, with emphasis on dental health.

Incorrect. Cardiac rehabilitation including physical exercise training should be considered in clinically stable patients based on an individual assessment. (Class IIa, Level C.)

Correct! (Class I, Level C.)

Correct! Patient education on the risk of recurrence and preventive measures, with emphasis on dental health, and based on the individual risk profile, is recommended during follow-up. (Class I, Level C.)

Correct! Psychosocial support may be considered to be integrated in follow-up care, including screening for anxiety and depression, and referral to relevant psychological treatment. (Class IIb, Level C.)

Incorrect. According to the following study, young age was associated with an increased incidence of embolic events.“Durante Mangoni E, Adinolfi LE, Tripodi MF, Andreana A, Gambardella M, Ragone E, et al. Risk factors for “major” embolic events in hospitalized patients with infective endocarditis. Am Heart J 2003;146:311–316. https://doi.org/10.1016/S0002-8703(02)94802-7”

Incorrect. In this population, enterococci and S. aureus are reported to be the most frequent etiological agents.

Correct! Higher presence of cardiovascular implanted electronic devices (CIED) and valvular prosthesis/repair including transcatheter aortic valve implantation (TAVI) devices in this population increase the incidence of intracardiac devices-related IE.

Correct! The elderly have an increased incidence of healthcare-associated IE episodes.

Correct! (Class I, Level A.)

Correct! (Class IIa, Level C.)

Incorrect. TTE and TOE are both recommended in case of suspected CIED-related IE to identify vegetations. (Class I, Level B.)

Incorrect. Obtaining at least three sets of blood cultures is recommended before prompt initiation of empirical antibiotic therapy for CIED infection, covering methicillin-resistant staphylococci and Gram-negative bacteria.

Correct! Complete CIED extraction should be considered in case of valvular IE, even without definite lead involvement, taking into account the identified pathogen and requirement for valve surgery. (Class IIa, Level C.)

Incorrect. Removal of CIED after a single positive blood culture, with no other clinical evidence of infection, is not recommended. (Class III, Level C.)

Correct! In cases of possible CIED-related IE with occult Gram-positive bacteraemia or fungaemia, complete system removal should be considered in case bacteraemia/fungaemia persists after a course of antimicrobial therapy. (Class IIa, Level C.)

Incorrect. in patients with definite CIED-related IE complete system extraction IS RECOMMENDED without delay and under initial empirical antibiotic therapy. (Class I, Level B.)

Correct! In patients with IE due to oral streptococci and S. gallolyticus group, penicillin G, amoxicillin, or ceftriaxone are recommended for 4 weeks in NVE, using the following doses:Penicillin G 12–18 million U/day i.v. either in 4–6 doses or continuously.Amoxicillin 100–200 mg/kg/day i.v. in 4–6 doses.Ceftriaxone 2 g/day i.v. in 1 dose.(Class I, Level B.)

Correct! 2-week treatment with penicillin G, amoxicillin, ceftriaxone combined with gentamicin is recommended only for the treatment of non-complicated NVE due to oral streptococci and S. gallolyticus in patients with normal renal function, using the following doses:Penicillin G 12–18 million U/day i.v. either in 4–6 doses or continuously.Amoxicillin 100–200 mg/kg/day i.v. in 4–6 doses.Ceftriaxone 2 g/day i.v. in 1 dose.Gentamicin 3 mg/kg/day i.v. or i.m. in 1 dosed.(Class I, Level B)

Incorrect. 2-week treatment with penicillin G, amoxicillin, ceftriaxone combined with gentamicin is recommended only for the treatment of non-complicated NVE and is not applicable to PVE. (Class I, Level B)

Incorrect. In patients with PVE due to oral streptococci and S. gallolyticus group, penicillin G, amoxicillin, or ceftriaxone are recommended for 6 weeks, using the following doses:Penicillin G 12–18 million U/day i.v. either in 4–6 doses or continuously.Amoxicillin 100–200 mg/kg/day i.v. in 4–6 doses.Ceftriaxone 2 g/day i.v. in 1 dose.(Class I, Level B.)

Incorrect. Cefazolin combined with rifampin for at least 6 weeks and gentamicin for 2 weeks is recommended in patients who are allergic to penicillin, with PVE due to methicillin-susceptible staphylococci. (Class I, Level B.)

Correct! Vancomycin for 6 weeks is recommended in patients allergic to beta-lactams and with PVE due to oral streptococci and S. gallolyticus, using the following doses:Vancomycin 30 mg/kg/day i.v. in 2 doses.(Class I, Level C.)

Correct! Vancomycin for 4 weeks is recommended in patients allergic to beta-lactams and with NVE due to oral streptococci and S. gallolyticus, using the following doses:Vancomycin 30 mg/kg/day i.v. in 2 doses.(Class I, Level C.)

Incorrect. Cefazolin for 4-6 weeks in NVE is recommended in patients who are allergic to penicillin, with NVE due to methicillin-susceptible staphylococci. (Class I, Level B.)

Incorrect. After a transient ischemic attack, cardiac surgery, if indicated, is recommended WITHOUT DELAY. (Class I, Level B.)

Correct! After a stroke, surgery is recommended without any delay in the presence of HF, uncontrolled infection, abscess, or persistent high embolic risk, as long as coma is absent and the presence of cerebral hemorrhage has been excluded by cranial CT or MRI. (Class I, Level B.)

Incorrect. Following intracranial hemorrhage, delaying cardiac surgery, if possible, with frequent re-assessment of the patient’s clinical condition and imaging should be considered after >1 month. (Class IIa, Level C.)

Correct! In this case urgent or emergency surgery should be considered weighing the likelihood of a meaningful neurological outcome. Especially if intracranial haemorrhage volume<30 mL or NIHSS <12.(Class IIa, Level C.)

Correct! In patients with NVE due to methicillin-susceptible staphylococci, (flu)cloxacillin or cefazolin is recommended for 4–6 weeks using the following doses:(Flu)cloxacillin 12 g/day i.v. in 4–6 doses.Cefazoline 6 g/day i.v. in 3 doses(Class I, Level B.)

Incorrect. In patients with PVE due to methicillin-susceptible staphylococci, (flu)cloxacillin or cefazolin with rifampin for at least 6 weeks and gentamicin for 2 weeks is recommended using the following doses:(Flu)cloxacillin 12 g/day i.v. in 4–6 doses.Cefazolin 6 g/day i.v. in 3 doses.Rifampin 900 mg/day i.v. or orally in 3 equally divided doses.Gentamicin 3 mg/kg/day i.v. or i.m. in 1 (preferred) or 2 doses.(Class I, Level B.)

Incorrect. Vancomycin for 4–6 weeks is recommended in patients with NVE due to methicillin-resistant staphylococci.

Incorrect. Vancomycin with rifampin for at least 6 weeks and gentamicin for 2 weeks is recommended in patients with PVE due to methicillin-resistant staphylococci.

Correct! In patients with NVE due to methicillin-susceptible staphylococci who are allergic to penicillin, cefazolin for 4–6 weeks is recommended using the following doses:Cefazoline 6 g/day i.v. in 3 doses. (Class I, Level B)

Correct! In patients with PVE due to methicillin-susceptible staphylococci who are allergic to penicillin, daptomycin combined with ceftaroline or fosfomycin or gentamicin with rifampin for at least 6 weeks and gentamicin for 2 weeks may be considered using the following doses:Daptomycin 10 mg/kg/day i.v. in 1 dose.Ceftaroline 1800 mg/day i.v. in 3 doses or Fosfomycin 8–12 g/day i.v. in 4 doses.Rifampin 900 mg/day i.v. or orally in 3 equally divided doses.Gentamicin 3 mg/kg/day i.v. or i.m. in 1 (preferred) or 2 doses.(Class IIb, Level C.)

Incorrect. In patients with PVE due to methicillin-susceptible staphylococci who are allergic to penicillin, cefazolin combined with rifampin for at least 6 weeks and gentamicin for 2 weeks is recommended using the following doses:Cefazoline 6 g/day i.v. in 3 doses.Rifampin 900 mg/day i.v. or orally in 3 equally divided doses.Gentamicin 3 mg/kg/day i.v. or i.m. in 1 (preferred) or 2 doses.(Class I, Level B.)

Incorrect. In patients with NVE due to methicillin-susceptible staphylococci who are allergic to penicillin, daptomycin combined with ceftaroline or fosfomycin may be considered. (Class IIb, Level C.)

Correct! Surgery is recommended. (Class I, Level B.)

Correct! Surgery is recommended. (Class I, Level B.)

Incorrect. Surgery is recommended in patients with large residual tricuspid vegetations (>20 mm) after recurrent septic pulmonary emboli. (Class I, Level C.)

Correct! Surgery is recommended. (Class I, Level C.)

Correct! In patients with NVE due to methicillin-resistant staphylococci, daptomycin combined with cloxacillin, ceftaroline or fosfomycin may be considered using the following doses:Daptomycin 10 mg/kg/day i.v. in 1 dose.Cloxacillin 0 mg/kg/day i.v. in 1 dose OR Ceftaroline 1800 mg/day i.v. in 3 doses OR Fosfomycin 8–12 g/day i.v. in 4 doses.(Class IIb, Level C.)

Correct! In patients with PVE due to methicillin-resistant staphylococci, vancomycin with rifampin for at least 6 weeks and gentamicin for 2 weeks is recommended using the following doses:Vancomycin 30–60 mg/kg/day i.v. in 2–3 doses.Rifampin 900–1200 mg/day i.v. or orally in 2 or 3 divided doses.Gentamicin 3 mg/kg/day i.v. or i.m. in 1 (preferred) or 2 doses.(Class I, Level B.)

Correct! In patients with NVE due to methicillin-resistant staphylococci, vancomycin is recommended for 4–6 weeks using the following doses:Vancomycin 30–60 mg/kg/day i.v. in 2–3 doses.(Class I, Level B.)

Incorrect. Cefazolin is recommended for 4–6 weeks in patients with NVE due to methicillin-susceptible staphylococci. (Class I, Level B.)

Correct! In patients with NVE due to non-HLAR Enterococcus spp., the combination of ampicillin or amoxicillin with ceftriaxone for 6 weeks or with gentamicin for 2 weeks is recommended using the following doses:Amoxicillin 200 mg/kg/day i.v. in 4–6 dosesAmpicillin 12 g/day i.v. in 4–6 dosesCeftriaxone 4 g/day i.v. in 2 dosesGentamicin 3 mg/kg/day i.v. or i.m. in 1 dose(Class I, Level B.)

Correct! In patients with PVE and patients with complicated NVE or >3 months of symptoms due to non-HLAR Enterococcus spp., the combination of ampicillin or amoxicillin with ceftriaxone for 6 weeks or with gentamicin for 2 weeks is recommended using the following doses:Amoxicillin 200 mg/kg/day i.v. in 4–6 dosesAmpicillin 12 g/day i.v. in 4–6 dosesCeftriaxone 4 g/day i.v. in 2 dosesGentamicin 3 mg/kg/day i.v. or i.m. in 1 dose(Class I, Level B.)

Incorrect. Vancomycin for 6 weeks combined with gentamicin for 2 weeks is recommended in patients with IE due to beta-lactam resistant Enterococcus spp. (E. faecium).

Incorrect. Daptomycin combined with beta-lactams is recommended In patients with IE due to vancomycin-resistant Enterococcus spp.

Incorrect. Vancomycin for 6 weeks combined with gentamicin for 2 weeks is recommended in patients with IE due to beta-lactam resistant Enterococcus spp. (E. faecium).

Incorrect. Ampicillin or amoxicillin with ceftriaxone for 6 weeks or with gentamicin for 2 weeks is recommended in patients with NVE due to non-HLAR Enterococcus spp.

Correct! In patients with native valve endocarditis (NVE) or prosthetic valve endocarditis (PVE) due to HLAR Enterococcus spp., the combination of ampicillin or amoxicillin and ceftriaxone for 6 weeks is recommended using the following doses:Ampicillin 12 g/day i.v. in 4–6 doses.Amoxicillin 200 mg/kg/day i.v. in 4–6 doses.Ceftriaxone 4 g/day i.v. or i.m. in 2 doses.(Class I, Level B.)

Incorrect. Daptomycin combined with beta-lactams is recommended In patients with IE due to vancomycin-resistant Enterococcus spp.

Incorrect. Daptomycin combined with beta-lactams is recommended In patients with IE due to vancomycin-resistant Enterococcus spp.

Incorrect. Ampicillin or amoxicillin with ceftriaxone for 6 weeks or with gentamicin for 2 weeks is recommended in patients with native valve endocarditis (NVE) due to non-high-level aminoglycoside resistance (HLAR) Enterococcus spp.

Incorrect. The combination of ampicillin or amoxicillin and ceftriaxone for 6 weeks is recommended in patients with native valve endocarditis (NVE) or prosthetic valve endocarditis (PVE) due to high-level aminoglycoside resistance (HLAR) Enterococcus spp.

Correct! In patients with IE due to beta-lactam resistant Enterococcus spp. (E. faecium), vancomycin for 6 weeks combined with gentamicin for 2 weeks is recommended using the following doses:Vancomycin 30 mg/kg/day i.v. in 2 doses.Gentamicin 3 mg/kg/day i.v. or i.m. in 1 dose.(Class I, Level C.)

Correct! In patients with IE due to vancomycin-resistant Enterococcus spp., daptomycin combined with beta-lactams (ampicillin, ertapenem, or ceftaroline) or fosfomycin is recommended using the following doses:Daptomycin 10–12 mg/kg/day i.v. in 1 dose.Ampicillin 300 mg/kg/day i.v. in 4–6 equally divided doses.Fosfomycin 12 g/day i.v. in 4 doses.Ceftaroline 1800 mg/day i.v. in 3 doses.Ertapenem 2 g/day i.v. or i.m. in 1 dose.(Class I, Level B.)

Incorrect. Vancomycin for 6 weeks combined with gentamicin for 2 weeks is recommended in patients with IE due to beta-lactam resistant Enterococcus spp. (E. faecium).

Incorrect. Combination of ampicillin or amoxicillin and ceftriaxone for 6 weeks is recommended in patients with native valve endocarditis (NVE) or prosthetic valve endocarditis (PVE) due to high-level aminoglycoside resistance (HLAR) Enterococcus spp.

Incorrect. Ampicillin or amoxicillin with ceftriaxone for 6 weeks or with gentamicin for 2 weeks is recommended in patients with NVE due to non-high-level aminoglycoside resistance (HLAR) Enterococcus spp.

Correct! This is the most common reason for negative blood culture in infective endocarditis.

Incorrect. Staphylococcus aureus is usually responsible for acute and destructive infective endocarditis with positive blood culture.

Correct! For diagnosis, serology (IgG phase l >1:800), tissue culture, immunohistology and 16S rRNA sequencing of tissue are recommended

Correct! For diagnosis, serology, tissue culture, immunohistology and 16S rRNA sequencing of tissue are recommended.

Incorrect. At least 3 sets of blood cultures should be obtained at 30-minute intervals prior to antibiotic therapy, each containing 10 mL of blood.

Correct! Sampling should be obtained from a peripheral vein rather than from a central venous catheter because of a risk of contamination and misleading interpretation.

Incorrect. Blood culture must be obtained before administering antibiotic therapy.

Incorrect. There is no rationale for delaying blood sampling to coincide with peaks of fever. In IE bacteraemia is almost constant and nearly all blood cultures are positive during bacteraemia.

Incorrect. Coronary angiography is recommended for post-menopausal woman because of an increased risk of coronary artery disease (CAD).

Incorrect. Coronary angiography is recommended for men >40 years because of an increased risk of coronary artery disease (CAD).

Incorrect. Coronary angiography is recommended if a patient has one or more cardiovascular risk factors or history of CAD.

Correct! The presence of aortic valve vegetations may preclude invasive coronary angiography due to the risk of iatrogenic embolization. In this cases, CT coronary angiography is recommended.

Correct! In patients with community-acquired NVE od PVE>12 months from surgery ampicillin in combination with (flu)cloxacillin and ceftriaxone or gentamicin should be considered using the following doses:Ampicillin 12 g/day i.v. in 4–6 doses.Ceftriaxone 4 g/day i.v. or i.m. in 2 doses.(Flu)cloxacillin 12 g/day i.v. in 4–6 doses.Gentamicin 3 mg/kg/day i.v. or i.m. in 1 dose.(Class IIa, Level C.)

Incorrect. Vancomycin or daptomycin combined with gentamicin and rifampin may be considered in patients with early PVE (<12 months post-surgery) or nosocomial and non-nosocomial healthcare-associated IE. In patients with community-acquired NVE ampicillin in combination with ceftriaxone or with (flu)cloxacillin and gentamicin should be considered .

Incorrect. In patients with community-acquired NVE ampicillin in combination with (flu)cloxacillin and ceftriaxone or gentamicin should be considered.

Incorrect. In patients with community-acquired NVE ampicillin in combination with (flu)cloxacillin and ceftriaxone or gentamicin should be considered.

Incorrect. In patients with late PVE (≥12 months post-surgery) ampicillin in combination with (flu)cloxacillin and ceftriaxone or gentamicin should be considered

Correct! In patients with late PVE (≥12 months post-surgery) ampicillin ampicillin in combination with (flu)cloxacillin and ceftriaxone or gentamicin should be considered using the following doses:Ampicillin 12 g/day i.v. in 4–6 doses.Ceftriaxone 4 g/day i.v. or i.m. in 2 doses.(Flu)cloxacillin 12 g/day i.v. in 4–6 doses.Gentamicin 3 mg/kg/day i.v. or i.m. in 1 dose.(Class IIa, Level C.)

Incorrect. Vancomycin or daptomycin combined with gentamicin and rifampin may be considered in patients with early PVE (<12 months post-surgery) or nosocomial and non-nosocomial healthcare-associated IE. In patients with late PVE (≥12 months post-surgery) ampicillin in combination with (flu)cloxacillin and ceftriaxone or gentamicin should be considered

Incorrect. In patients with late PVE (≥12 months post-surgery) ampicillin in combination with (flu)cloxacillin and ceftriaxone or gentamicin should be considered

Correct! EMERGENCY surgery is recommended in aortic or mitral NVE or PVE with severe acute regurgitation, obstruction, or fistula causing refractory pulmonary oedema or cardiogenic shock. (Class I, Level B.)

Incorrect. In this case URGENT (within 3-5 days) surgery is recommended. (Class I, Level B.)

Incorrect. In this case URGENT (within 3-5 days) surgery should be considered. (Class IIa, Level B.)

Incorrect. In this case URGENT (within 3-5 days) surgery may be considered. (Class IIb, Level B.)

Incorrect. In patients with early (<12 months post-surgery) prosthetic valve endocarditis (PVE) vancomycin or daptomycin combined with gentamicin and rifampin may be considered.

Incorrect. In patients with early (<12 months post-surgery) prosthetic valve endocarditis (PVE) vancomycin or daptomycin combined with gentamicin and rifampin may be considered.

Correct! In patients with early (<12 months post-surgery) prosthetic valve endocarditis (PVE) vancomycin or daptomycin combined with gentamicin and rifampin may be considered using the following doses:Vancomycin 30 mg/kg/day i.v. in 2 dosesDaptomycin 10 mg/kg/day i.v. in 1 doseGentamicin 3 mg/kg/day i.v. or i.m. in 1 doseRifampin 900–1200(Class IIb, Level C.)

Incorrect. Ampicillin in combination with ceftriaxone or with (flu)cloxacillin should be considered in patients with late PVE (≥12 months post-surgery) or with community-acquired NVE. In patients with early (<12 months post-surgery) prosthetic valve endocarditis (PVE) vancomycin or daptomycin combined with gentamicin and rifampin may be considered.

Incorrect. The tricuspid valve is much more commonly infected than the pulmonary valve in patients with right-sided IE.

Incorrect. The most common microorganism causing right-sided IE is S. aureus.

Correct! Adequate evaluation of the tricuspid valve may be performed with TTE, due to the anterior location of the valve and large vegetations frequently observed in right-sided IE.

Correct! Right-sided IE is more benign and can be medically managed in ∼90% of patients.

Correct! Anticoagulant treatment should be considered in all patients and should be balanced against the individual patient’s bleeding risk. Patients may be anticoagulated with low-molecular-weight heparin, vitamin K antagonists, or unfractionated heparin. There are no data to support the use of direct oral anticoagulants in NBTE.

Incorrect. Thrombolytic therapy is NOT recommended in patients with IE. (Class III, Level C.)

Correct! In the absence of stroke, replacement of oral anticoagulant therapy by unfractionated heparin under close monitoring should be considered in cases where indication for surgery is likely (e.g. S. aureus IE). (Class IIa, Level C.)

Incorrect. Interruption of antiplatelet or anticoagulant therapy is recommended in the presence of major bleeding (including intracranial haemorrhage). (Class I, Level C.)

Incorrect. This is a minor criterion.

Correct! Blood cultures positive for IE:(a) Typical microorganisms consistent with IE from two separate blood cultures:Oral streptococci, Streptococcus gallolyticus (formerly S. bovis), HACEK group, S. aureus, E. faecalis.(b) Microorganisms consistent with IE from continuously positive blood cultures:• ≥2 positive blood cultures of blood samples drawn >12 h apart.• All of 3 or a majority of ≥4 separate cultures of blood (with first and last samples drawn ≥1 h apart).(c) Single positive blood culture for C. burnetii or phase I IgG antibody titer >1:800.

Incorrect. This is a minor criterion.

Correct! Imaging positive for IE:Valvular, perivalvular/periprosthetic and foreign material anatomic and metabolic lesions characteristic of IE detected by any of the following imaging techniques:• Echocardiography (TTE and TOE).• Cardiac CT.• [18F]-FDG-PET/CT(A).• WBC SPECT/CT.

Correct! The highest risk of IE is observed in patient with previous history of IE who have an ominous prognosis during IE-related hospitalization. Patients with recurrent IE more frequently have prosthetic valves or prosthetic material, are more commonly people who inject drugs (PWID) or have staphylococcal IE.

Correct! Patients with surgically implanted prosthetic valves, with transcatheter implanted prosthetic valves, and with any material used for cardiac valve repair: the increased risk of IE in these patients, combined with the ominous outcomes as compared with patients with native valve IE (NVE).

Incorrect. Patients with septal defect closure devices, left atrial appendage closure devices, vascular grafts, vena cava filters, and central venous system ventriculo-atrial shunts are considered within this risk category in the first 6 months after implantation.

Incorrect. They are considered at intermediate risk of IE.

Incorrect. Patients with ventricular assist devices as destination therapy are considered at high risk because of associated morbidity and mortality.

Correct! Patients at intermediate risk of IE include those with: rheumatic heart disease, non-rheumatic degenerative valve disease, congenital valve abnormalities including bicuspid aortic valve disease, cardiovascular implanted electronic devices and hypertrophic cardiomyopathy.

Incorrect. They are considered as high risk for IE development.

Correct! Patients at intermediate risk of IE include those with: rheumatic heart disease, non-rheumatic degenerative valve disease, congenital valve abnormalities including bicuspid aortic valve disease, cardiovascular implanted electronic devices and hypertrophic cardiomyopathy.

Correct! (Class I, Level A.)

Correct! (Class I, Level B.)

Incorrect. Systematic skin or nasal decolonization without screening for S. aureus is not recommended. (Class III, Level C.)

Correct! (Class I, Level A.)

Correct! TTE is recommended as the first-line imaging modality in suspected IE. (Class I, Level B.)

Incorrect. Performing an echocardiography should be considered in S. aureus, E. faecalis, and some Streptococcus spp. bacteraemia. (Class IIa, Level B.)

Incorrect. TOE is recommended in patients with suspected IE, even in cases with positive TTE, except in isolated right-sided native valve IE with good quality TTE examination and unequivocal echocardiographic findings. (Class I, Level C.)

Incorrect. TOE is recommended when the patient is stable before switching from intravenous to oral antibiotic therapy. (Class I, Level B.)