For all patients with suspected or confirmed IE seen at one of the participating centers (and in particular, to ensure the maximal sensitivity, at one of the echocardiography services), a “warning alarm form” was faxed to the coordinating center (Clinic of Infectious Diseases, University of Udine, Udine, Italy) and included information on patient demographics, admittance hospital and ward, and attending physician and attending cardiologist with contact information for follow-up. In the following days, a standardized, detailed case report form was completed by the attending physician, including demographic, clinical (predisposing conditions and risk factors), radiological, microbiological, laboratory, treatment (including surgery), and outcome (at the end of treatment) data. Because this was an observational study, no indication was given as to antibiotic treatment or surgical indications. Dedicated medical personnel ensured that all cases notified to the system via the warning alarm forms had a case record form completed. Case record forms were sent to the coordinating center, where they were reviewed by a panel that comprised an infectious disease specialist (P.V.) and an expert on echocardiography (L.B.) to ensure that the diagnosis of IE was consistent with modified Duke criteria.4 Data were subsequently entered into an electronic database created with Access (Microsoft Corp, Redmond, Washington) by the aforementioned medical personnel, who also checked data completeness and consistency and, if needed, issued queries to the relevant clinical center. Cases not residing in FVG were excluded from the present report. Cross-checking with the regional database of discharge medical records was periodically performed to ensure that all cases were notified to the system.