Comparison between transthoracic and transesophageal echocardiography in screening for infective endocarditis in patients with Staphylococcus aureus bacteremia

2014 ◽  
Vol 33 (11) ◽  
pp. 2053-2059 ◽  
Author(s):  
D. Wong ◽  
Y. Keynan ◽  
E. Rubinstein
Keyword(s):  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Transesophageal Echocardiography ◽  
Staphylococcus Aureus Bacteremia

scholarly journals Comparative Sensitivity of Transthoracic and Transesophageal Echocardiography in Diagnosis of Infective Endocarditis Among Veterans With Staphylococcus aureus Bacteremia

2017 ◽  
Vol 4 (2) ◽  
Author(s):  
Poorani Sekar ◽  
James R. Johnson ◽  
Joseph R. Thurn ◽  
Dimitri M. Drekonja ◽  
Vicki A. Morrison ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Transesophageal Echocardiography ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Valve Surgery ◽  
Related Factors ◽  
Staphylococcus Aureus Bacteremia ◽  
Patient Refusal

Abstract Background Echocardiography is fundamental for diagnosing infective endocarditis (IE) in patients with Staphylococcus aureus bacteremia (SAB), but whether all such patients require transesophageal echocardiography (TEE) is controversial. Methods We identified SAB cases between February 2008 and April 2012. We compared sensitivity and specificity of transthoracic echocardiography (TTE) and TEE for evidence of IE, and we determined impacts of IE risk factors and TTE image quality on comparative sensitivities of TTE and TEE and their impact on clinical decision making. Results Of 215 evaluable SAB cases, 193 (90%) had TTE and 130 (60%) had TEE. In 119 cases with both tests, IE was diagnosed in 29 (24%), for whom endocardial involvement was evident in 25 (86%) by TEE, vs only 6 (21%) by TTE (P < .001). Transesophageal echocardiography was more sensitive than TTE regardless of risk factors. Even among the 66 cases with adequate or better quality TTE images, sensitivity was only 4 of 17 (24%) for TTE, vs 16 of 17 (94%) for TEE (P < .001). Among 130 patients with TEE, the TEE results, alone or with TTE results, influenced treatment duration in 56 (43%) cases and led to valve surgery in at least 4 (6%). It is notable that, despite vigorous efforts to obtain both tests routinely, TEE was not done in 86 cases (40%) for various reasons, including pathophysiological contraindications (14%), patient refusal or other patient-related factors (16%), and provider declination or system issues (10%). Conclusions Patients with SAB should undergo TEE when possible to detect evidence for IE, especially if the results might affect management.

scholarly journals Clinical Risk Factors for Infective Endocarditis in Staphylococcus aureus Bacteremia

2017 ◽  
Vol 44 (1) ◽  
pp. 10-15 ◽  
Author(s):  
Vincent Bryan D. Salvador ◽  
Bikash Chapagain ◽  
Astha Joshi ◽  
Debra J. Brennessel
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
High Risk ◽  
Transesophageal Echocardiography ◽  
Univariate Analysis ◽  
Clinical Risk Factors ◽  
Methicillin Resistant ◽  
Clinical Risk ◽  
Staphylococcus Aureus Bacteremia

Crucial to the management of staphylococcal bacteremia is an accurate evaluation of associated endocarditis, which has both therapeutic and prognostic implications. Because the clinical presentation of endocarditis can be nonspecific, the judicious use of echocardiography is important in distinguishing patients at high risk of developing endocarditis. In the presence of high-risk clinical features, an early transesophageal echocardiogram is warranted without prior transthoracic echocardiography. The purpose of this study was to investigate the clinical risk factors for staphylococcal infective endocarditis that might warrant earlier transesophageal echocardiography and to describe the incidence of endocarditis in cases of methicillin-resistant and methicillin-sensitive Staphylococcus aureus bacteremia. A retrospective case-control study was conducted by means of chart review of 91 patients consecutively admitted to a community hospital from January 2009 through January 2013. Clinical risk factors of patients with staphylococcal bacteremia were compared with risk factors of patients who had definite diagnoses of infective endocarditis. There were 69 patients with bacteremia alone (76%) and 22 patients with endocarditis (24%), as verified by echocardiography. Univariate analysis showed that diabetes mellitus (P=0.024), the presence of an automatic implantable cardioverter-defibrillator/pacemaker (P=0.006) or a prosthetic heart valve (P=0.003), and recent hospitalization (P=0.048) were significantly associated with developing infective endocarditis in patients with S. aureus bacteremia. The incidence of methicillin-resistant and methicillin-sensitive S. aureus bacteremia was similar in the bacteremia and infective-endocarditis groups (P=0.437). In conclusion, identified high-risk clinical factors in the presence of bacteremia can suggest infective endocarditis. Early evaluation with transesophageal echocardiography might well be warranted.

scholarly journals 925A Normal Transthoracic Echocardiogram can be Used to Rule Out Infective Endocarditis in Patients with Staphylococcus aureus Bacteremia

2014 ◽  
Vol 1 (suppl_1) ◽  
pp. S267-S267
Author(s):  
Adrienne Showler ◽  
Lisa Burry ◽  
Anthony Bai ◽  
Daniel Ricciuto ◽  
Marilyn Steinberg ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Transthoracic Echocardiogram ◽  
Staphylococcus Aureus Bacteremia ◽  
Rule Out

scholarly journals Benefit of Echocardiography in Patients With Staphylococcus aureus Bacteremia at Low Risk of Endocarditis

2018 ◽  
Vol 5 (12) ◽  
Author(s):  
George S Heriot ◽  
Steven Y C Tong ◽  
Allen C Cheng ◽  
Danny Liew
Keyword(s):  
Staphylococcus Aureus ◽  
Transesophageal Echocardiography ◽  
Low Risk ◽  
Prosthetic Devices ◽  
Staphylococcus Aureus Bacteremia ◽  
Absolute Benefit ◽  
Short Course ◽  
Small Influence ◽  
Therapy Strategies ◽  
Test Treatment

Abstract Background The risk of endocarditis among patients with Staphylococcus aureus bacteremia is not uniform, and a number of different scores have been developed to identify patients whose risk is less than 5%. The optimal echocardiography strategy for these patients is uncertain. Methods We used decision analysis and Monte Carlo simulation using input parameters taken from the existing literature. The model examined patients with S aureus bacteremia whose risk of endocarditis is less than 5%, generally those with nosocomial or healthcare-acquired bacteremia, no intracardiac prosthetic devices, and a brief duration of bacteremia. We examined 6 echocardiography strategies, including the use of transesophageal echocardiography, transthoracic echocardiography, both modalities, and neither. The outcome of the model was 90-day survival. Results The optimal echocardiography strategy varied with the risk of endocarditis and the procedural mortality associated with transesophageal echocardiography. No echocardiography strategy offered an absolute benefit in 90-day survival of more than 0.5% compared with the strategy of not performing echocardiography and treating with short-course therapy. Strategies using transesophageal echocardiography were never preferred if the mortality of this procedure was greater than 0.5%. Conclusions In patients identified to be at low risk of endocarditis, the choice of echocardiography strategy appears to exert a very small influence on 90-day survival. This finding may render test-treatment trials unfeasible and should prompt clinicians to focus on other, more important, management considerations in these patients.

Risk Factors for Infective Endocarditis and Outcome of Patients With Staphylococcus aureus Bacteremia

2007 ◽  
Vol 82 (10) ◽  
pp. 1165-1169 ◽  
Author(s):  
Evelyn E. Hill ◽  
Steven Vanderschueren ◽  
Jan Verhaegen ◽  
Paul Herijgers ◽  
Piet Claus ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Staphylococcus Aureus Bacteremia

scholarly journals Clinical Reasoning of Infectious Diseases Physicians Behind the Use or Nonuse of Transesophageal Echocardiography in Staphylococcus aureus Bacteremia

2016 ◽  
Vol 3 (4) ◽  
Author(s):  
Heather Young ◽  
Bryan C. Knepper ◽  
Connie S. Price ◽  
Susan Heard ◽  
Timothy C. Jenkins
Keyword(s):  
Staphylococcus Aureus ◽  
Infectious Diseases ◽  
Transesophageal Echocardiography ◽  
Clinical Reasoning ◽  
Prospective Cohort ◽  
Treatment Duration ◽  
Blood Cultures ◽  
Extended Treatment ◽  
Staphylococcus Aureus Bacteremia ◽  
Rapid Clearance

Abstract In this prospective cohort with Staphylococcus aureus bacteremia, transesophageal echocardiography (TEE) was performed in 24% of cases. Consulting Infectious Diseases physicians most frequently cited low suspicion for endocarditis due to rapid clearance of blood cultures and the presence of a secondary focus requiring an extended treatment duration as reasons for foregoing TEE.

scholarly journals 1171-206 Frequency of infective endocarditis among infants and children with staphylococcus aureus bacteremia

2004 ◽  
Vol 43 (5) ◽  
pp. A394
Author(s):  
Anne Marie Valente ◽  
Rajiv Jain ◽  
Mark Scheurer ◽  
Vance Fowler ◽  
G Ralph Corey ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Infants And Children ◽  
Staphylococcus Aureus Bacteremia
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