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Highlights Many factors confer increased risk of recurrent endocarditis. Often many of these factors co-exist in the same host. There is always the risk of residual infected endocardial tissue despite repeated debridement. The traditional 4–6 week parenteral course in endocarditis accounts for bacterial tolerance and antimicrobial resistance. The decision on antimicrobial therapy and duration are supported by evidence but should be individualized.

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