Staphylococcus aureus bacteraemia in a UK tertiary referral centre: a 'transoesophageal echocardiogram for all' policy

Holden, Elisabeth; Bashir, Ahmed Muhammad; Das, Ira; Morton, H. R.; Steadman, Christopher D; Steeds, Richard P.; David, M

doi:10.1093/jac/dku082

Cited by 24 publications

(23 citation statements)

References 23 publications

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“…In particular, transoesophageal echocardiography (TEE) is often not performed due to comorbidity, limited acceptance by patients or treating physicians [12], even though other authors showed that performing routinely TEE results in a high incidence of the most feared complication: infective endocarditis [17]. …”

Section: Introductionmentioning

confidence: 99%

Implementing a hospital-wide protocol for Staphylococcus aureus bacteremia

Bolhuis

Bakker

Keijer

et al. 2018

Eur J Clin Microbiol Infect Dis

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Staphylococcus aureus bacteraemia (SAB) is associated with high-mortality and complication rates. A multidisciplinary approach is needed to predict, detect and treat complications. In this pre- and post-intervention study, we investigated the effects of a hospital-wide protocol for diagnosis, classification and treatment of SAB. It was hypothesized that complications and endocarditis would be better identified and treated. Medical records of SAB patients admitted in 2011 and 2012 (pre) were analysed. In 2013, a protocol, describing risk factors, diagnostic classification and recommended treatment, was implemented. In 2014 and 2015 (post), SAB patients were followed prospectively. Transthoracic (TTE) or transoesophageal cardiac ultrasound (TEE) was chosen following a decision tree. A resident internal medicine acted as contact person. Pre-intervention, 98 patients were eligible for analysis compared to 85 patients post-intervention. Age and number of risk factors were slightly higher post-intervention; other baseline characteristics were similar. Most SAB-patients were classified as complicated (89 and 82% pre- and post-intervention, respectively). Follow-up blood cultures drawn within 2 days after initiating treatment increased from 51 to 85%. Cardiac ultrasounds increased from 44 to 83% for TTE and 13 to 24% for TEE. Endocarditis was more frequently diagnosed (4 vs. 12%). Additionally, duration of antibiotic therapy increased. The 3-month mortality did not change significantly (33% pre-intervention vs. 35% post-intervention; p > 0.05). Introduction of a hospital-wide protocol for SAB management increased standard of care, created awareness among clinicians to properly classify SAB, search for endocarditis and adapt duration of antibiotic treatment. Mortality did not decrease.

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Section: Introductionmentioning

confidence: 99%

Implementing a hospital-wide protocol for Staphylococcus aureus bacteremia

Bolhuis

Bakker

Keijer

et al. 2018

Eur J Clin Microbiol Infect Dis

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“…Although 5 high-risk criteria had >97% sensitivity and >99% negative predictive value for IE in nosocomial SAB (14), diagnostic properties were less robust when these criteria were applied to a prospective cohort that also included community-acquired and health careassociated SAB (15). Khatib and Sharma (15) found however, the majority did not receive any form of cardiac imaging (14,15), and other studies with higher rates of echocardiography utilization do not support the use of clinical predictors alone to rule out IE (8,12,19).…”

Section: Resultsmentioning

confidence: 99%

“…Identification of IE is crucial because patients require a more complex approach to management, which includes prolonged use of intravenous antibiotic therapy (10,11). The majority of patients with IE do not have clinically evident disease at the time of bacteremia, which makes early diagnosis challenging (4, 8,12).…”

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confidence: 99%

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Use of Transthoracic Echocardiography in the Management of Low-Risk Staphylococcus aureus Bacteremia

Showler

Burry

Bai

et al. 2015

JACC: Cardiovascular Imaging

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“…14 Most recently, 13 of 98 SAB patients (16%) were found to have IE in a “mandatory TEE” approach. 15 …”

Section: Results Of Evidence Reviewmentioning

confidence: 99%

Clinical Management ofStaphylococcus aureusBacteremia

Holland

Arnold

Fowler

2014

JAMA

380

261

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Importance Several management strategies may improve outcomes in patients with Staphylococcus aureus bacteremia (SAB). The strength of evidence supporting these management strategies, however, varies widely. Objective To perform a systematic review of the evidence for two unresolved questions involving management strategies for SAB: 1) is transesophageal echocardiography (TEE) necessary in all cases of SAB; and 2) what is the optimal antibiotic therapy for methicillin resistant Staphylococcus aureus (MRSA) bacteremia? Evidence acquisition A PubMed search from inception through May 2014 was performed to find studies that addressed the role of TEE in SAB. A second search of PubMed, EMBASE, and The Cochrane Library from 1/1/1990 to 5/28/2014 was performed to find studies that addressed antibiotic treatment of MRSA bacteremia. Studies that reported outcomes of systemic antibiotic therapy for MRSA bacteremia were included. All searches were augmented by review of bibliographic references from included studies. The quality of evidence was assessed using the GRADE system by consensus of independent evaluations by at least two authors. Results In 9 studies with a total of 3513 patients, use of TEE was associated with higher rates of diagnosis of endocarditis (14–25%) when compared with TTE (2–14%). Five studies proposed criteria to identify patients in whom TEE might safely be avoided. Only one high-quality trial of antibiotic therapy for MRSA bacteremia was identified from the 83 studies considered. Conclusions and relevance Most contemporary management strategies for SAB are based upon low quality evidence. TEE is indicated in most patients with SAB. It may be possible to identify a subset of SAB patients for whom TEE can be safely avoided. Vancomycin and daptomycin are the first-line antibiotic choices for MRSA bacteremia. Well-designed studies to address the management of SAB are desperately needed.

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Staphylococcus aureus bacteraemia in a UK tertiary referral centre: a 'transoesophageal echocardiogram for all' policy

Cited by 24 publications

References 23 publications

Implementing a hospital-wide protocol for Staphylococcus aureus bacteremia

Implementing a hospital-wide protocol for Staphylococcus aureus bacteremia

Use of Transthoracic Echocardiography in the Management of Low-Risk Staphylococcus aureus Bacteremia

Clinical Management ofStaphylococcus aureusBacteremia

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