Which of the following is a major criterion for endocarditis?

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Infective endocarditis is diagnosed using Duke criteria, which separate findings into major and minor categories. The major criteria include microbiologic evidence from blood cultures and direct imaging evidence of endocardial involvement. Two positive blood cultures for organisms typically causing endocarditis, drawn on separate occasions, provide strong, specific confirmation of active infection on the heart valves. This persistence and pattern of bacteremia makes it a defining major criterion. Elevated ESR is nonspecific and can occur in many inflammatory conditions, so it isn’t a major criterion. A new murmur can be a clue but isn’t by itself a major criterion unless paired with other confirming findings, and positive transesophageal echocardiography is a major criterion only if it clearly shows vegetation or other endocardial involvement. So the two positive blood cultures stand out as the definitive major criterion.