*8. Suspicion of IE in HD patients? Always use TEE*

TTE if not conclusive TEE to rule out or confirm the diagnosis; if TTE conclusive, use TEE to rule out other cardiac lesions or unidentified vegetations in other valves.

#### *9. Vancomycin not as prophylactic*

Confirm IE in HD patients; do not use prophylactic vancomycin if you suspect any pathogen different from MRSA.

#### *10. Mechanical prosthesis not the only option for IE in HD patients*

Biological prosthesis is a good option for these patients; the heart team must individualize each case; and consider the benefits or disadvantages of mechanical or biological prosthesis.
