Positive blood cultures during transesophageal echocardiography

Infective endocarditis in the grown-up congenital heart (GUCH) population

“…In the two patients in whom it appeared to be a cause, one had a skin infection at the puncture area and the other had a long procedure. New techniques, such as therapeutic interventions (stent and devices), and transoesophageal echocardiography can also cause infective endocarditis [17,18] . This raises the need for antibiotics prophylaxis for such procedures.…”

Is antibiotic prophylaxis ever necessary before transoesophageal echocardiography?

“…5 By contrast, antibiotic prophylaxis has been thought not to be routinely necessary in 11 studies involving 1063 patients. 6-9 11-16 19 Of these, eight studies considered that antibiotic prophylaxis was never routinely recommended, while three 6 11 13 suggested that prophylaxis could be considered in individual patients with prosthetic valves or after previous endocarditis.…”

“…Streptococcus viridans is the most likely precursor of subsequent endocarditis and only one instance of viridans bacteraemia has been demonstrated. 5 Thus, significant bacteraemia appears to be a rare event after TOE. Considering that some sort of allergic reaction occurs in between 7 and 40 of every 1000 courses of penicillin 17 18 and that there is little evidence for its benefit in dental and other procedures leading to much higher rates of bacteraemia, its routine use for TOE is inappropriate.…”

Transesophageal echocardiography and antibiotic prophylaxis for infective endocarditis

“…Passage of the transductor through the oropharynx and proximal oesophagus may cause mucosal disruption with subsequent access of colonizing bacteria to the bloodstream[2]. The reported incidence of bacteremia following this procedure has ranged from 0 to 17%[3–5]. Nonetheless, the American Heart Association (AHA) considers TEE a low risk procedure for which antibiotic prophylaxis of endocarditis is not routinely necessary.…”

“…Görge et al . [4], however, did recommend its systematic use based on an observed incidence of bacteremia of 17% after TEE. Other authors have documented rates of post‐TEE bacteremia lower than 5%, leading to varying recommendations[5–11].…”