Do you routinely order karius in evaluation of culture negative prosthetic valve endocarditis?  

Don’t “routinely” order Karius test. Rarely, in culture-negative suspected endocarditis, especially if a prosthetic valve is present. Once for suspected culture-negative aortic graft infection. 3x for culture-negative meningitis.  Likely to become more frequent but adoption v...

No. I usually wait for pathology and sequencing.

Not routine although a lot of that is due to financial barriers at our institution. Likely to become more common practice as most recent Duke Endocarditis guidelines endorse it for C. burnetii, Bartonella spp. and T. whipplei.