Does transesophageal echocardiography improve the detection of infective endocarditis and impact clinical decision making compared to transthoracic echocardiography in veterans with Staphylococcus aureus bacteremia?
Transesophageal echocardiography frequently alters clinical management in patients with Staphylococcus aureus bacteremia, supporting its use when possible to detect infective endocarditis.
BACKGROUND: 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: < .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.
Sekar et al. (Sun,) studied this question.