Heart failure
Shock
Disruption or perforation of valve
Cardiac abscess, new heart block, pseudoaneurysm, fistula
Fungal IE
Staphylococcus prosthetic IE
Persistent bacteremia or lack of clinical improvement after 7d of adequate therapy
Relapse after full course of therapy
Persistent vegetation after systemic major emboli
Vegetation >10mm, especially on anterior mitral leaflet
Multiple major embolic events
Increase in vegetation size after 14d appropriate therapy