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a high baseline IE prevalence. In addition to the clinical picture, this flowchart based on streptococcal species, number of positive blood culture bottles, and risk factors, can help guide the use of echocardiography in streptococcal bloodstream infections. Since echocardiography results are not available the findings should be confirmed prospectively with the use of systematic echocardiography. In addition to the clinical picture, this flowchart based on streptococcal species, number of positive blood culture bottles, and risk factors