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Cited by 3,232Infective Endocarditis Diagnosis and ManagementStreptococcal Infections and TreatmentsCardiac Valve Diseases and Treatments

The DOI matches its Crossref record, with a small difference in title or year; 344 of the 347 references it cites were found in a registry or an index, and 2 are not checked yet; 102 of the 369 sources its claims cite were checked for support.

Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association

Baddour, Larry M., Wilson, Walter R., Bayer, Arnold S., Fowler, Vance G., Tleyjeh, Imad M., Rybak, Michael J., Barsic, Bruno, Lockhart, Peter B., Gewitz, Michael H., Levison, Matthew E., Bolger, Ann F., Steckelberg, James M., Baltimore, Robert S., Fink, Anne M., O’Gara, Patrick, Taubert, Kathryn A., on behalf of the American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Stroke Council·2015·Circulation
DOI 10.1161/cir.0000000000000296
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Abstract

BACKGROUND: Infective endocarditis is a potentially lethal disease that has undergone major changes in both host and pathogen. The epidemiology of infective endocarditis has become more complex with today's myriad healthcare-associated factors that predispose to infection. Moreover, changes in pathogen prevalence, in particular a more common staphylococcal origin, have affected outcomes, which have not improved despite medical and surgical advances. METHODS AND RESULTS: This statement updates the 2005 iteration, both of which were developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It includes an evidence-based system for diagnostic and treatment recommendations used by the American College of Cardiology and the American Heart Association for treatment recommendations. CONCLUSIONS: Infective endocarditis is a complex disease, and patients with this disease generally require management by a team of physicians and allied health providers with a variety of areas of expertise. The recommendations provided in this document are intended to assist in the management of this uncommon but potentially deadly infection. The clinical variability and complexity in infective endocarditis, however, dictate that these recommendations be used to support and not supplant decisions in individual patient management.

Verified 2026-10-11 · 2 references not checked yet

Overview

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Crossref · 10.1161/cir.0000000000000296

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344 of 347 references verified1 citation errors · 0 not checkable

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Claims the paper makes

163 No full text of the sources · 36 Partly supported · 33 No basis given · 32 Supported · 27 Own interpretation · 13 Sources not found · 10 Not checked yet · 8 Supported so far · 6 Couldn’t confirm · 2 Mixed support · 2 Not supported · 2 Own result · accuracy not yet measured

Show all 229 claims

  • It may state two separate claims as one. 88
  • Probably not a substantial claim. 18
  • The quote only partly states this claim. 2
105 of 105

  • The paper relies on this without support.

    Outcomes of infective endocarditis have not improved despite medical and surgical advances.

    “changes in pathogen prevalence, in particular a more common staphylococcal origin, have affected outcomes, which have not improved despite medical and surgical advances.”

  • The paper relies on this without support.

    The modified Duke criteria are universally accepted.

    “These additional parameters have not been formally integrated into the modified Duke criteria, 24 however, which are universally accepted.”

  • The paper relies on this without support.

    Host characteristics such as impaired immunity contribute to challenges in treating IE.

    “Host characteristics such as impaired immunity also contribute to challenges in therapeutics.”

  • The paper relies on this without support.

    Antibiotics may fail to eradicate infection as a result of increased binding of the drug to serum proteins, perturbations of antibiotic penetration into the vegetation, and unique antibiotic PK/PD features.

    “In addition, antibiotics may fail to eradicate infection as a result of increased binding of the drug to serum proteins, perturbations of antibiotic penetration into the vegetation, and unique antibiotic pharmacokinetic/pharmacodynamic (PK/PD) features.”

  • The paper relies on this without support.

    For enterococci, bactericidal activity can be achieved by the combination of certain β-lactam antibiotics with an aminoglycoside.

    “For enterococci, bactericidal activity can be achieved by the combination of certain β-lactam antibiotics (eg, penicillin, ampicillin, and piperacillin) with an aminoglycoside.”

  • The paper relies on this without support.

    The rate of bactericidal activity against some other organisms can be enhanced by a combination of a β-lactam antibiotic plus an aminoglycoside.

    “The rate of bactericidal activity against some other organisms can also be enhanced by a combination of a β-lactam antibiotic plus an aminoglycoside.”

  • The paper relies on this without support.

    The addition of gentamicin sulfate to penicillin exerts a synergistic killing effect in vitro on VGS and S gallolyticus (bovis).

    “The addition of gentamicin sulfate to penicillin exerts a synergistic killing effect in vitro on VGS and S gallolyticus (bovis).”

  • The paper relies on this without support.

    The combination of penicillin or ceftriaxone with gentamicin results in synergistic killing in animal models of VGS or S gallolyticus (bovis) experimental IE.

    “The combination of penicillin or ceftriaxone with gentamicin results in synergistic killing in animal models of VGS or S gallolyticus (bovis) experimental IE.”

  • The paper relies on this without support.

    Both penicillin and ceftriaxone are overall well tolerated but have the potential for causing adverse drug events; common ones include rash, fever, diarrhea, and neutropenia.

    “Both penicillin and ceftriaxone are overall well tolerated but, like all antimicrobials, have the potential for causing adverse drug events; some of the more common ones include rash, fever, diarrhea, and neutropenia.”

  • The paper relies on this without support.

    Prolonged intravenous use of vancomycin may be complicated by thrombophlebitis, rash, fever, neutropenia, and rarely ototoxic reactions.

    “Prolonged intravenous use of vancomycin may be complicated by thrombophlebitis, rash, fever, neutropenia, and rarely ototoxic reactions.”

  • The paper relies on this without support.

    The likelihood of red man syndrome is reduced with an infusion of vancomycin over at least 1 hour.

    “The likelihood of “red man” syndrome is reduced with an infusion of vancomycin over ≥1 hour.”

  • The paper relies on this without support.

    Penicillin resistance in vitro occurs among some strains of VGS and S gallolyticus (bovis).

    “Penicillin resistance in vitro occurs among some strains of VGS and S gallolyticus (bovis).”

  • The paper relies on this without support.

    In non-IDUs, S aureus infective endocarditis involves primarily the left side of the heart.

    “In non-IDUs, S aureus IE involves primarily the left side of the heart and is associated with mortality rates ranging from 25% to 40%.”

  • The paper relies on this without support.

    In non-IDUs, S aureus infective endocarditis is associated with mortality rates ranging from 25% to 40%.

    “In non-IDUs, S aureus IE involves primarily the left side of the heart and is associated with mortality rates ranging from 25% to 40%.”

  • The paper relies on this without support.

    S aureus infective endocarditis in IDUs often involves the tricuspid valve.

    “S aureus IE in IDUs often involves the tricuspid valve.”

  • The paper relies on this without support.

    Most CoNS are resistant to methicillin.

    “Most CoNS are resistant to methicillin.”

  • The paper relies on this without support.

    S lugdunensis tends to cause a substantially more virulent form of infective endocarditis, with a high rate of perivalvular extension of infection and metastatic infection.

    “This species of CoNS tends to cause a substantially more virulent form of IE, with a high rate of perivalvular extension of infection and metastatic infection.”

  • The paper relies on this without support.

    Cefazolin has inadequate blood-brain barrier penetrability.

    “In cases of brain abscess complicating MSSA IE, nafcillin is the preferred agent rather than cefazolin, which has inadequate blood-brain barrier penetrability.”

  • The paper relies on this without support.

    Current laboratory screening procedures for detecting penicillin susceptibility may not be reliable.

    “Unfortunately, the current laboratory screening procedures for detecting penicillin susceptibility may not be reliable.”

  • The paper relies on this without support.

    Enterococci are the third leading cause of infective endocarditis and account for approximately 10% of cases in non-IDUs.

    “Enterococci are the third leading cause of IE and account for ≈10% of cases in non-IDUs.”

  • The paper relies on this without support.

    E faecalis causes approximately 97% of cases of enterococcal infective endocarditis; E faecium causes approximately 1% to 2%; and other species cause approximately 1%.

    “E faecalis causes ≈97% of cases of IE; E faecium, ≈1% to 2%; and other species, ≈1%.”

  • The paper relies on this without support.

    Killing of susceptible strains of enterococci requires the synergistic action of penicillin, ampicillin, or vancomycin in combination with either gentamicin or streptomycin.

    “Killing of susceptible strains of enterococci requires the synergistic action of penicillin, ampicillin, or vancomycin in combination with either gentamicin or streptomycin.”

  • The paper relies on this without support.

    Enterococci are relatively impermeable to aminoglycosides.

    “Enterococci are relatively impermeable to aminoglycosides.”

  • The paper relies on this without support.

    High concentrations of aminoglycosides in the extracellular environment are required to achieve sufficient concentrations of the drug at the ribosomal target within the bacterial cell for bactericidal activity.

    “High concentrations of aminoglycosides in the extracellular environment are required to achieve sufficient concentrations of the drug at the site of the ribosomal target within the bacterial cell for bactericidal activity.”

  • The paper relies on this without support.

    If an enterococcal strain is resistant to the cell wall-active agent or high concentrations of an aminoglycoside, then the combination of an aminoglycoside and the cell wall-active agent will not result in bactericidal activity in vitro or in vivo, nor predictably produce a microbiological cure in human enterococcal infective endocarditis.

    “If an enterococcal strain is resistant to the cell wall-active agent or high concentrations of an aminoglycoside (500 µg/mL gentamicin or 1000 µg/mL streptomycin), then the combination of an aminoglycoside and the cell wall-active agent will not result in bactericidal activity in vitro or in vivo (ie, in experimental IE models), nor will it predictably produce a microbiological cure in human enter”

  • The paper relies on this without support.

    Since the 2005 AHA statement on antimicrobial therapy of patients with infective endocarditis, the frequency of aminoglycoside-resistant strains of enterococci has increased significantly.

    “Since the publication of the latest (2005) AHA statement on antimicrobial therapy of patients with IE, 12 the frequency of aminoglycoside-resistant strains of enterococci has increased significantly.”

  • The paper relies on this without support.

    Approximately 97% of cases of enterococcal infective endocarditis are caused by E faecalis, and the majority of these remain susceptible to beta-lactams and vancomycin, but aminoglycoside resistance is increasing in frequency.

    “Approximately 97% of cases of enterococcal IE are caused by E faecalis, and the majority of these remain susceptible to β-lactams and vancomycin, but aminoglycoside resistance is increasing in frequency.”

  • The paper relies on this without support.

    Patients with preexisting mild or severe renal failure may not be able to safely complete a 4- to 6-week course of gentamicin therapy because of gentamicin-associated nephrotoxicity.

    “Patients with preexisting mild (creatinine clearance, 30-50 mL/min) or severe (creatinine clearance, <30 mL/min) renal failure may not be able to safely complete a 4-to 6-week course of gentamicin therapy because of gentamicin-associated nephrotoxicity.”

  • The paper relies on this without support.

    Streptomycin is less nephrotoxic than gentamicin.

    “The main advantage is that streptomycin is less nephrotoxic than gentamicin.”

  • The paper relies on this without support.

    Streptomycin has a higher risk of ototoxicity than gentamicin, which may not be reversible.

    “There are several disadvantages of using streptomycin-containing regimens, including a lack of familiarity among clinicians with streptomycin, a higher risk of ototoxicity, which may not be reversible, and drug availability limitations.”

  • The paper relies on this without support.

    Most strains of E faecalis are inhibited but not killed in vitro by penicillin or ampicillin, with MICs usually 2 to 4 µg/mL penicillin; ampicillin MICs are usually 1 dilution lower.

    “Most strains of E faecalis are inhibited but not killed in vitro by penicillin or ampicillin, with MICs usually 2 to 4 µg/ mL penicillin; ampicillin MICs are usually 1 dilution lower.”

  • The paper relies on this without support.

    Cephalosporins and antistaphylococcal penicillins have minimal or no in vitro activity against enterococci.

    “Cephalosporins and antistaphylococcal penicillins (oxacillin, nafcillin) have minimal or no in vitro activity against enterococci.”

  • The paper relies on this without support.

    The in vitro activity of carbapenems is variable, with imipenem being most active.

    “The in vitro activity of carbapenems is variable, with imipenem being most active.”

  • The paper relies on this without support.

    The likely mechanism of double-β-lactam combinations against enterococci is saturation of different penicillin-binding proteins.

    “The likely mechanism of double-β-lactam combinations against enterococci is saturation of different penicillin-binding proteins.”

  • The paper relies on this without support.

    The potential disadvantage of ampicillin-ceftriaxone is the possibility of hypersensitivity reactions to 2 separate β-lactams.

    “The potential disadvantage is the possibility of hypersensitivity reactions to 2 separate β-lactams.”

  • The paper relies on this without support.

    Aminoglycoside resistance in enterococci is most commonly the result of acquisition of plasmid-mediated aminoglycoside-modifying enzymes.

    “Aminoglycoside resistance in enterococci is most commonly the result of the acquisition of plasmid-mediated aminoglycoside-modifying enzymes.”

  • The paper relies on this without support.

    E faecalis strains resistant to high levels of gentamicin are resistant to most other aminoglycosides, although some are susceptible to streptomycin.

    “E faecalis strains resistant to high levels of gentamicin are resistant to most other aminoglycosides, although some of them are susceptible to streptomycin.”

  • The paper relies on this without support.

    The total number of cases published in European studies far exceeds the relatively small number of reported streptomycin-treated patients with enterococcal IE.

    “The total number of cases published in the European studies far exceeds the relatively small number of reported streptomycin-treated patients with enterococcal IE.”

  • The paper relies on this without support.

    Combinations of penicillin or ampicillin with gentamicin are preferable to combined vancomycin-gentamicin because of the potential increased risk of ototoxicity and nephrotoxicity with the vancomycin-gentamicin combination.

    “Combinations of penicillin or ampicillin with gentamicin are preferable to combined vancomycin-gentamicin because of the potential increased risk of ototoxicity and nephrotoxicity with the vancomycin-gentamicin combination.”

  • The paper relies on this without support.

    Combinations of penicillin or ampicillin and gentamicin are more active than combinations of vancomycin and gentamicin in vitro and in animal models of experimental IE.

    “Moreover, combinations of penicillin or ampicillin and gentamicin are more active than combinations of vancomycin and gentamicin in vitro and in animal models of experimental IE.”

  • The paper relies on this without support.

    Rarely, strains of E faecalis produce an inducible β-lactamase.

    “Rarely, strains of E faecalis produce an inducible β-lactamase.”

  • The paper relies on this without support.

    β-lactamase-producing E faecalis strains are susceptible to ampicillin-sulbactam and to vancomycin.

    “These β-lactamase-producing strains are susceptible to ampicillin-sulbactam and to vancomycin.”

  • The paper relies on this without support.

    Intrinsic penicillin resistance is uncommon in E faecalis but is common in E faecium.

    “Intrinsic penicillin resistance is uncommon in E faecalis but is common in E faecium.”

  • The paper relies on this without support.

    Most vancomycin-resistant enterococci are E faecium, and as many as 95% of strains express multidrug resistance to vancomycin, aminoglycosides, and penicillins.

    “Most of these strains are E faecium, and as many as 95% of strains express multidrug resistance to vancomycin, aminoglycosides, and penicillins.”

  • The paper relies on this without support.

    Only about 3% of E faecalis strains are multidrug resistant, and many vancomycin-resistant E faecalis are penicillin susceptible.

    “Only about 3% of E faecalis strains are multidrug resistant, and many vancomycin-resistant E faecalis are penicillin susceptible.”

  • The paper relies on this without support.

    E faecium IE is uncommon.

    “Fortunately, E faecium IE is uncommon.”

  • The paper relies on this without support.

    Linezolid and daptomycin are the only 2 antimicrobial agents currently available in the United States that may be useful for treatment of multidrug-resistant E faecium IE.

    “Linezolid and daptomycin are the only 2 antimicrobial agents currently available in the United States that may be useful for the treatment of multidrug-resistant E faecium IE.”

  • The paper relies on this without support.

    Quinupristin-dalfopristin may be active in vitro but only against E faecium and is inactive against E faecalis.

    “Quinupristin-dalfopristin may be active in vitro but only against strains of E faecium and is inactive against E faecalis.”

  • The paper relies on this without support.

    Quinupristin-dalfopristin is rarely used because of severe side effects, including intractable muscle pain.

    “Quinupristin-dalfopristin is rarely used because of severe side effects, including intractable muscle pain.”

  • The paper relies on this without support.

    Tigecycline is active in vitro against some strains of multidrug-resistant enterococci, but there are minimal published data on its clinical use.

    “Tigecycline is active in vitro against some strains of multidrug-resistant enterococci, but there are minimal published data on its use clinically.”

  • The paper relies on this without support.

    Linezolid is bacteriostatic in vitro against enterococci, and susceptibility ranges from 97% to 99%, including multidrug-resistant strains.

    “Linezolid is bacteriostatic in vitro against enterococci, and susceptibility of enterococci to linezolid ranges from 97% to 99%, including strains that are multidrug resistant.”

  • The paper relies on this without support.

    Daptomycin has bactericidal activity in vitro against susceptible strains of enterococci.

    “Daptomycin is a cyclic lipopeptide antibiotic that has bactericidal activity in vitro against susceptible strains of enterococci.”

  • The paper relies on this without support.

    HACEK microorganisms grow slowly in standard blood culture media, and recovery may require prolonged incubation.

    “These microorganisms grow slowly in standard blood culture media, and recovery may require prolonged incubation.”

  • The paper relies on this without support.

    Typically, only a small fraction of blood culture bottles in patients with HACEK IE demonstrate growth.

    “Typically, only a small fraction of blood culture bottles in patients with HACEK IE demonstrate growth.”

  • The paper relies on this without support.

    Bacteremia caused by HACEK microorganisms in the absence of an obvious focus of infection is highly suggestive of IE even without typical physical findings.

    “Bacteremia caused by HACEK microorganisms in the absence of an obvious focus of infection is highly suggestive of IE even without typical physical findings of IE.”

  • The paper relies on this without support.

    Almost all strains of the HACEK group are susceptible to ceftriaxone (or other third- or fourth-generation cephalosporins).

    “Almost all strains of the HACEK group are susceptible to ceftriaxone (or other third-or fourth-generation cephalosporins).”

  • The paper relies on this without support.

    There are only a few case reports of HACEK IE treated with a fluoroquinolone.

    “There are only a few case reports of HACEK IE treated with a fluoroquinolone, however.”

  • The paper relies on this without support.

    IE caused by non-HACEK Gram-negative aerobic bacilli is rare.

    “IE caused by non-HACEK Gram-negative aerobic bacilli (Enterobacteriaceae and Pseudomonas species) is rare.”

  • The paper relies on this without support.

    Prospective trial data are lacking to define the optimal antimicrobial regimen for IE caused by non-HACEK Gram-negative aerobic bacilli.

    “Prospective trial data are lacking to define the optimal antimicrobial regimen for the treatment of IE caused by non-HACEK Gram-negative aerobic bacilli.”

  • The paper relies on this without support.

    Medical therapy may be successful in right-sided P aeruginosa IE in 50% to 75% of cases.

    “Medical therapy may be successful in right-sided P aeruginosa IE in 50% to 75% of cases.”

  • The paper relies on this without support.

    Patients with right-sided P aeruginosa IE have typically been IDUs and have high recidivism risk.

    “Typically, these patients have been IDUs, and because of their high recidivism risk, avoidance of placement of prosthetic valves is desirable.”

  • The paper relies on this without support.

    Continuous bacteremia and a high frequency of positive blood cultures are typical hallmarks of IE.

    “Continuous bacteremia and a high frequency of positive blood cultures are typical hallmarks of this infection.”

  • The paper relies on this without support.

    Failure to culture microorganisms that cause IE can be a major problem that complicates diagnosis and timely, effective treatment.

    “Failure to culture microorganisms that cause IE can be a major problem that complicates diagnosis and timely, effective treatment.”

  • The paper relies on this without support.

    The causes of culture-negative IE may include inadequate microbiological techniques, infection with highly fastidious bacteria or fungi, noncultivatable agents, or previous administration of antimicrobial agents before blood cultures.

    “This may be attributable to inadequate microbiological techniques, infection with highly fastidious bacteria or fungi, noncultivatable agents, or the previous administration of antimicrobial agents before blood cultures were obtained.”

  • The paper relies on this without support.

    IE patients with blood cultures initially negative after only a few days of antibiotic therapy may have positive blood cultures after several days without antibiotics.

    “IE patients with blood cultures that are initially negative after only a few days of antibiotic therapy may have positive blood cultures after several days without antibiotics.”

  • The paper relies on this without support.

    The blood cultures of patients who receive longer courses of high-dose bactericidal antimicrobials may remain negative for weeks.

    “The blood cultures of patients who receive longer courses of high-dose bactericidal antimicrobials may remain negative for weeks.”

  • The paper relies on this without support.

    Certain therapeutic agents, including aminoglycosides, have potentially toxic effects that dictate limitation or avoidance of use if at all possible.

    “On the other hand, certain therapeutic agents, including aminoglycosides, have potentially toxic effects that dictate limitation or avoidance of use if at all possible.”

  • The paper relies on this without support.

    During the period between collection of blood cultures and determination of a pathogen, patients are often treated empirically for the more common bacterial causes of IE, which can result in exposure to potentially toxic therapy that could be avoided with earlier pathogen identification.

    “During this period, patients are often treated empirically for the more common bacterial causes of IE, which can result in exposure to potentially toxic therapy that could be avoided with earlier pathogen identification.”

  • The paper relies on this without support.

    During the period between collection of blood cultures and determination of a pathogen or if blood cultures are ultimately deemed culture negative, empirical therapy is generally required.

    “During the period between the collection of blood cultures and the determination of a pathogen or if blood cultures are ultimately deemed culture negative, empirical therapy is generally required.”

  • The paper relies on this without support.

    Collection of additional clinical and laboratory data often dictates subsequent revisions in initial empirical therapy.

    “Collection of additional clinical and laboratory data often dictates subsequent revisions in initial empirical therapy that will be administered over the treatment course.”

  • The paper relies on this without support.

    The organisms that have garnered the most attention as causes of culture-negative IE are Bartonella species, Chlamydia species, C burnetii, Brucella species, Legionella species, Tropheryma whipplei, Candida, and non-Candida fungi.

    “The organisms that have garnered the most attention are Bartonella species, Chlamydia species, C burnetii, Brucella species, Legionella species, Tropheryma whipplei, Candida, and non-Candida fungi (particularly Aspergillus species).”

  • The paper relies on this without support.

    The last 2 groups of organisms (Candida and non-Candida fungi) are especially relevant to PV recipients.

    “The last 2 groups of organisms are especially relevant to PV recipients.”

  • The paper relies on this without support.

    With special diagnostic techniques, Bartonella species, C burnetii, and Brucella species have been identified in the majority of cases of culture-negative IE caused by fastidious organisms.

    “With the use of special diagnostic techniques, Bartonella species, C burnetii, and Brucella species have been identified in the majority of cases of culture-negative IE caused by fastidious organisms.”

  • The paper relies on this without support.

    In some cases, serological and special blood culture techniques can be helpful for culture-negative IE.

    “In some cases, serological and special blood culture techniques can be helpful.”

  • The paper relies on this without support.

    In other cases, tissue (usually valve) screening is required for culture-negative IE.

    “In other cases, tissue (usually valve) screening is required.”

  • The paper relies on this without support.

    Diagnostic methods for resected valve tissue include microbiological, histopathological, and molecular techniques, the last of which includes gene amplification with PCR.

    “Diagnostic methods for resected valve tissue include microbiological, histopathological, and molecular techniques, the last of which includes gene amplification with PCR methods.”

  • The paper relies on this without support.

    Most clinical laboratories do not perform molecular screening, and specimens must be sent to reference laboratories.

    “Unfortunately, most clinical laboratories do not perform molecular screening, and specimens must be sent to reference laboratories.”

  • The paper relies on this without support.

    Incidence data from population-based surveys for IE caused by these organisms are lacking in the United States.

    “Incidence data from population-based surveys for IE caused by these organisms are lacking in the United States.”

  • The paper relies on this without support.

    Treatment of culture-negative IE without prior antibiotic exposure is based on limited data.

    “Treatment of the wide variety of microorganisms that cause culture-negative IE without prior antibiotic exposure has been described anecdotally, and regimens of choice are based on limited data and can be found in other publications.”

  • The paper relies on this without support.

    Noninfectious causes of valvular vegetations can produce a syndrome similar to culture-negative IE.

    “Noninfectious causes of valvular vegetations can produce a syndrome similar to culture-negative IE.”

  • The paper relies on this without support.

    Sterile valvular vegetations form and embolize, clinically mimicking culture-negative IE.

    “Sterile valvular vegetations form and embolize, clinically mimicking in many respects culture-negative IE.”

  • The paper relies on this without support.

    The mitral valve is most often affected, and valvular regurgitation is the predominant functional abnormality in APA syndrome with valvular involvement.

    “The mitral valve is most often affected, and valvular regurgitation is the predominant functional abnormality seen in APA syndrome with complicating valvular involvement.”

  • The paper relies on this without support.

    Numerous other causes of noninfective vegetative endocarditis can mimic IE.

    “Numerous other causes of noninfective vegetative endocarditis can mimic IE.”

  • The paper relies on this without support.

    The survival rate for patients with mold-related infective endocarditis is less than 20%.

    “The survival rate for patients with mold-related IE is <20%.”

  • The paper relies on this without support.

    Stroke is an independent risk factor for postoperative mortality in infective endocarditis patients.

    “Stroke is an independent risk factor for postoperative mortality in IE patients.”

  • The paper relies on this without support.

    The novel oral anticoagulants are not approved for use with either mechanical valves or bioprosthetic valves when risk factors for thromboembolism exist.

    “The novel oral anticoagulants are not approved for use with either mechanical valves or bioprosthetic valves when risk factors for thromboembolism exist (eg, atrial fibrillation).”

  • The paper relies on this without support.

    Clinical parameters for the diagnosis of perivalvular extension of IE are inadequate.

    “Clinical parameters for the diagnosis of perivalvular extension of IE are inadequate.”

  • The paper relies on this without support.

    TEE can demonstrate the distinctive flow patterns of fistulas and pseudoaneurysms and can rule out communications from unruptured abscess cavities.

    “When combined with spectral and color Doppler techniques, TEE can demonstrate the distinctive flow patterns of fistulas and pseudoaneurysms and can rule out communications from unruptured abscess cavities.”

  • The paper relies on this without support.

    The most frequent complications of IE are heart failure and systemic emboli.

    “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 paper relies on this without support.

    The period of greatest risk for systemic emboli is before or within the first 1 to 2 weeks of antimicrobial therapy.

    “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 antimicrobial therapy.”

  • The paper relies on this without support.

    Serious complications such as heart failure and rupture of MAs may develop weeks to months after the initiation of antimicrobial therapy.

    “although serious complications such as heart failure and rupture of MAs may develop weeks to months after the initiation of antimicrobial therapy.”

  • The paper relies on this without support.

    The risk for drug-related side effects usually increases with a prolonged drug exposure.

    “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 β-lactams and vancomycin; and nephrotoxicity resulting from the combination of vancomycin and gentamicin) and requires close monitoring by the home infusion team consisting of representatives from nursing and pha”

  • The paper relies on this without support.

    The majority of patients with IE are cured with appropriate medical and, if necessary, surgical treatment.

    “The majority of patients with IE are cured with appropriate medical and, if necessary, surgical treatment.”

  • The paper relies on this without support.

    Routine blood cultures after completion of antimicrobial therapy have a low likelihood of positive result in a patient who is otherwise without evidence of active infection.

    “Routine blood cultures are no longer recommended after the completion of antimicrobial therapy because the likelihood of a positive culture result in a patient who is otherwise without evidence of active infection is low.”

  • The paper relies on this without support.

    Developing or worsening heart failure is a complication that should be considered during short-term follow-up.

    “Developing or worsening heart failure is a second complication that should be considered during short-term followup.”

  • The paper relies on this without support.

    Valve function can deteriorate as a result of ongoing infection or mechanical stress unrelated to infection.

    “Although new onset of heart failure caused by valvular dysfunction is unlikely during this period, valve function can deteriorate as a result of ongoing infection or mechanical stress unrelated to infection.”

  • The paper relies on this without support.

    Antibiotic toxicity still can occur after the completion of treatment.

    “Antibiotic toxicity still can occur after the completion of treatment and is the third complication that should be considered during short-term follow-up.”

  • The paper relies on this without support.

    Delayed ototoxicity can occur because of previous use of aminoglycosides.

    “The first is delayed ototoxicity because of the previous use of aminoglycosides.”

  • The paper relies on this without support.

    No tools are routinely available for monitoring vestibular function.

    “No tools are routinely available for monitoring vestibular function, and patients should be told to report the onset of any symptoms of vestibular toxicity during or after treatment.”

  • The paper relies on this without support.

    Clostridium difficile infection is an antibiotic-related adverse event.

    “The second antibiotic-related adverse event is Clostridium difficile infection.”

  • The paper relies on this without support.

    Onset of C. difficile diarrhea can be delayed as long as 4 weeks after the last dose of antibiotic.

    “Onset of diarrhea can be delayed as long as 4 weeks after the last dose of antibiotic.”

  • The paper relies on this without support.

    IE can mimic a variety of febrile illnesses.

    “This is necessary because IE can mimic a variety of febrile illnesses.”

  • The paper relies on this without support.

    Antibiotics prescribed for nonspecific or unproved febrile syndromes are a major cause of culture-negative IE.

    “Antibiotics prescribed for nonspecific or unproved febrile syndromes are a major cause of (blood) culture-negative IE, and this practice should be strongly discouraged.”

  • The paper relies on this without support.

    Dental disease is almost entirely preventable if patients are compliant with 4 measures.

    “Dental disease is almost entirely preventable if patients are compliant with 4 measures.”

  • The paper relies on this without support.

    The cause of both periodontal disease and caries is bacterial plaque accumulation on teeth, and prevention is dependent on keeping teeth free of plaque.

    “First, the cause of both periodontal disease and caries is bacterial plaque accumulation on teeth, and prevention is dependent on keeping teeth free of plaque.”

  • The paper relies on this without support.

    The degree to which sugar and other refined carbohydrates are eliminated from the diet will have a major impact on the growth of pathogenic bacterial species, some of which are responsible for IE.

    “The degree to which sugar and other refined carbohydrates are eliminated from the diet will have a major impact on the growth of pathogenic bacterial species, some of which are responsible for IE.”

  • The paper relies on this without support.

    Daily use of a high-concentration fluoridated toothpaste will help to ensure that acid from plaque does not decalcify tooth structures and result in caries.

    “Finally, the daily use of a high-concentration fluoridated toothpaste will help to ensure that the acid from plaque does not decalcify tooth structures and result in caries.”

  • The paper relies on this without support.

    Fluoroquinolones are highly active in vitro against HACEK microorganisms.

    “Fluoroquinolones are highly active in vitro against HACEK microorganisms.”

  • The paper relies on this without support.

    Published data on the use of fluoroquinolones for endocarditis caused by HACEK are minimal.

    “Published data on the use of fluoroquinolones for endocarditis caused by HACEK are minimal.”

  • The paper relies on this without support.

    Intramuscular injection of ceftriaxone is painful.

    “Patientsshould be informed that intramuscular injection of ceftriaxone is painful.”
110 of 110

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

3 of 3

Citations

Cites

Show all 338 references

Research works printed but not linked: 3

  1. Kanavos K Antoniadou A Venetis C Gezerlis P Giamarellou H. Retrospective analysis of Duke’s criteria in 60 cases of infective endocarditis in Greece [abstract 138]. Paper presented at: Third International Symposium on Modern Concepts in Endocarditis; July 13–15 1995; Boston MA.
  2. 10.1016/S0025-6196(11)63302-8 · DOI
  3. 10.1016/S0025-6196(11)64307-3 · DOI

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Metadata

Authors
Baddour, L. M., Wilson, W. R., Bayer, A. S., Fowler, V. G., Tleyjeh, I. M., Rybak, M. J., Barsic, B., Lockhart, P. B., Gewitz, M. H., Levison, M. E., Bolger, A. F., Steckelberg, J. M., Baltimore, R. S., Fink, A. M., O’Gara, P., Taubert, K. A., & on behalf of the American Heart Association Committee on Rheumatic Fever, E.
Affiliations
American Heart Association (US)
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2015-10-13
Volume
132
Issue
15
Pages
1435-1486
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/cir.0000000000000296
OpenAlex
W1905008412
Cited by
3,232
References
338
Citations by year
2026: 265 · 2025: 337 · 2024: 350 · 2023: 337 · 2022: 348 · 2021: 344 · 2020: 346 · 2019: 301 · 2018: 258 · 2017: 207 · 2016: 120 · 2015: 12
FWCI
156.29
Type
journal article
Language
en
Update notices
Open access
closed
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
  • Touro Scholar (Touro College) (submittedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Infective Endocarditis Diagnosis and Management
  • Health Sciences › Medicine › Infectious Diseases › Streptococcal Infections and Treatments
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
Keywords
infective endocarditis, adults, diagnosis, antimicrobial therapy, complication management, Staphylococcus aureus, nosocomial infections, treatment guidelines
MeSH terms
Adult, Anti-Infective Agents, Anticoagulants, Candidiasis, Diagnostic Techniques, Cardiovascular, Endocarditis, Heart Valve Prosthesis, Humans, Rheumatic Heart Disease, Risk Factors, Staphylococcal Infections, Streptococcal Infections, Prosthesis-Related Infections, Bacteremia

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

A language model drew the claims from the paper on 2026-10-11, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-10-11 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Cited sources are checked with a language model’s help (gpt-6-sol).

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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