esc and aha guidelines 2015 on endocarditis in competition or synchrony in the 2015 guidelines of the european society of cardiology esc and the american heart association aha on infective endocarditis the diagnostics are based on the modified duke criteria the diagnosis can be confirmed by a combination of microorganisms demonstrated in culture or in situ with the detection of valvular lesions or abscess formation by an imaging modality using echocardiography positron emission tomography computed tomography petct cardioct or nuclear medical methods the management should be further improved by an interdisciplinary endocarditis team in a specifically designated reference center pharmaceutical treatment is largely unchanged and based on classical antibiotics in monotherapy or as combination therapy but for staphylococcal endocarditis gentamycin is no longer required as cardiac surgery is needed in 50 of the cases during the course of the disease the urgency for surgery depends on the extent of cardiac insufficiency the persistence of the pathogen despite antibiotic treatment and on neurological complications