Extending incubation of routine blood cultures does not increase the recovery of clinically significant pathogens causing endocarditis. Five-day incubation, using currently available media formulations and automated incubation and detection systems, is sufficient to recover the majority of true pathogens including HACEK \organisms. Alternative methods (such as serology, molecular, targeted fungal or mycobacterial cultures, or tissue histopathology) should be utilized, when clinically indicated, for detection of rarely encountered, fastidious organisms (Bartonella, Coxiella, Mycobacterium, dimorphic fungi) not recovered using routine blood cultures. Occasional exceptions may be appropriate and should be reviewed in consultation with an infectious disease specialist.