Staphylococcus aureus Bacteremia

• Seventy-two adult patients withStaphylococcus aureusbacteremia were prospectively studied clinically, serologically, and echocardiographically. Multivariate analysis identified four parameters that significantly predicted endocarditis in staphylococcemic patients at time of initial evaluation: (1) absence of a primary site of infection; (2) community acquisition of infection; (3) metastatic sequelae; and (4) valvular vegetations detected by echocardiography. Echocardiography was most predictive of endocarditis in patients with community-acquiredS aureusbacteremia from an obvious primary focus. In 11 (69%) of 16 patients with endocarditis and vegetations on two-dimensional echocardiography, this technique also revealed other important findings, including ventricular dilatation, and/or underlying valvular lesions. In 18% of patients withS aureusbacteremia without stigmata of endocarditis, echocardiography provided information that led to a diagnosis of endocarditis and a subsequent change in therapy. Our findings support the routine use of two-dimensional echocardiography in all cases of community-acquiredS aureusbacteremia to identify occult endocarditis in patients without classic stigmata of disease, and to provide important prognostic data in clinically apparent endocarditis. (Arch Intern Med1987;147:457-462)