Investigations

BEFORE starting antibiotics, three to five separate blood collections should be obtained after careful preparation of the phlebotomy site

The timing of collection is not important, because bacteraemia is expected to be relatively constant

ESR: Elevated; may be low with heart or renal failure

CRP: Elevated

FBC: Anemia, leucocytosis

Urine: RE to look for hematuria

U&E: Azotemia, high creatinine (Glomerulonephritis)

Echocardiography: The absence of vegetation does not exclude endocarditis. Vegetations are often not visualized in the early phases