Role of Echocardiography in Evaluation of Patients With Staphylococcus aureusBacteremia: Experience in 103 Patients
Key result
Adding TEE to TTE is linked to 100% sensitivity for IE detection in SAB.
- n=103
Why the study?
The incidence of infective endocarditis among patients with Staphylococcus aureus bacteremia varies widely, and distinguishing uncomplicated bacteremia from IE is therapeutically and prognostically important but often difficult.
Does transesophageal echocardiography improve the detection of infective endocarditis compared to transthoracic echocardiography alone in patients with Staphylococcus aureus bacteremia?
Population
103 consecutive patients with Staphylococcus aureus bacteremia presenting with fever and ≥ 1 positive blood culture
Comparison
Transesophageal echocardiography vs transthoracic echocardiography
Design
Prospective observational study
Follow-up
12 weeks
Authors
Discussion
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Implication
TEE is essential in the early evaluation of patients with Staphylococcus aureus bacteremia, as it significantly improves the detection of infective endocarditis compared to TTE alone.
Key Points
- To examine the diagnostic role and clinical utility of echocardiography in identifying infective endocarditis among patients with Staphylococcus aureus bacteremia.
- Prospective evaluation of 103 consecutive patients presenting with fever and at least one positive blood culture for Staphylococcus aureus.
- All participants underwent both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) with a 12-week clinical follow-up.
- Definite infective endocarditis occurred in 26 of 103 patients (25%) according to Duke criteria, despite clinical signs being apparent in only 7%.
- TTE showed a sensitivity of 32% and specificity of 100%, whereas adding TEE increased sensitivity to 100% with 99% specificity, detecting infection in 19% of TTE-negative and 21% of TTE-indeterminate cases.
- Sepsis-related mortality was significantly higher in patients with infective endocarditis than in those without (15% [4/26] vs. 3% [2/77], p = 0.03).
Study Design
Type
Observational (n=103)
Structured PICO
Does transesophageal echocardiography improve the detection of infective endocarditis compared to transthoracic echocardiography alone in patients with Staphylococcus aureus bacteremia?
P
Population
103 consecutive patients with Staphylococcus aureus bacteremia presenting with fever and ≥ 1 positive blood culture, followed for 12 weeks.
E
Exposure
Transesophageal echocardiography (TEE)
C
Comparator
Transthoracic echocardiography (TTE)
O
Outcome
Detection of infective endocarditis (IE) using Duke criteria
Main Result
Absolute Event Rate: 100% vs 32%
TEE is essential in the early evaluation of patients with Staphylococcus aureus bacteremia, as it significantly improves the detection of infective endocarditis compared to TTE alone.
Cite This Study
Fowler et al. (1997) conducted an observational in Staphylococcus aureus bacteremia (n=103). Transesophageal echocardiography (TEE) vs. Transthoracic echocardiography (TTE) was evaluated on Sensitivity for detecting infective endocarditis. The addition of transesophageal echocardiography to transthoracic echocardiography increased the sensitivity for detecting infective endocarditis from 32% to 100% in patients with SAB.