The Potential Impact of Contemporary Transthoracic Echocardiography on the Management of Patients with Native Valve Endocarditis: A Comparison with Transesophageal Echocardiography

Casella, Francesco; Rana, Bushra S.; Casazza, Giovanni; Bhan, Amit; Kapetanakis, Stam; Omigie, Joe; Reiken, Joseph; M.Sc., Mark J. Monaghan

doi:10.1111/j.1540-8175.2009.00906.x

Cited by 41 publications

(16 citation statements)

References 35 publications

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“…Indeed, improvements in TTE image quality have already narrowed the diagnostic gap between the two modalities, especially for the evaluation of native valves. 69 Collectively, these results suggest that all patients with SAB should undergo echocardiography. 3,70 Although TEE is preferred when feasible, there may be identifiable low-risk patients in whom TEE is not required.…”

Section: Discussionmentioning

confidence: 90%

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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Section: Discussionmentioning

confidence: 90%

Clinical Management ofStaphylococcus aureusBacteremia

Holland

Arnold

Fowler

2014

JAMA

380

261

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“…Transesophageal echocardiography (TEE) is often used as a supplement to transthoracic echocardiography (TTE) when evaluating IE as the sensitivity of TTE is around 50%, while that for TEE approaches 100%. However, the most recent technologic advances have improved the image quality of TTE and a recent study have reported the sensitivity for detection of native valve IE by TTE to be as much as 82% [60]. The improved ability of TTE to detect vegetations in patients with native valves makes it a valuable screening tool and may eventually reduce the need for TEE, although TEE is still preferred in patients with high suspicion of IE due to the high sensitivity [60].…”

Section: Infective Endocarditis (Ie)mentioning

confidence: 99%

Future Challenges And Treatment Of Staphylococcus Aureus Bacteremia With Emphasis On MRSA

et al. 2010

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Summary Staphylococcus aureus bacteremia (SAB) is an urgent medical problem due to its growing frequency and its poor associated outcome. As healthcare delivery increasingly involves invasive procedures and implantable devices, the number of patients at risk for SAB and its complications is likely to grow. Compounding this problem is the growing prevalence of methicillin resistant S. aureus (MRSA) and the dwindling efficacy of vancomycin, long the treatment of choice for this pathogen. Despite the recent availability of several new antibiotics for S. aureus, new strategies for treatment and prevention are required for this serious, common cause of human infection.

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“…Modern echocardiographic techniques and equipment have improved TTE sensitivity in SAB, particularly in low-risk patients (16)(17)(18). TTE might therefore exclude IE in many patients and eliminate the need for more invasive testing with TEE (19).…”

mentioning

confidence: 99%

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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The Potential Impact of Contemporary Transthoracic Echocardiography on the Management of Patients with Native Valve Endocarditis: A Comparison with Transesophageal Echocardiography

Abstract: Contemporary TTE has improved the diagnostic accuracy of infective endocarditis by ameliorating image quality; it provides an accurate assessment of endocarditis and may reduce the need for TEE.

Cited by 41 publications

References 35 publications

Clinical Management ofStaphylococcus aureusBacteremia

Clinical Management ofStaphylococcus aureusBacteremia

Future Challenges And Treatment Of Staphylococcus Aureus Bacteremia With Emphasis On MRSA

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

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