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

Showler, Adrienne; Burry, Lisa; Bai, Anthony D.; Steinberg, Marilyn; Ricciuto, Daniel R.; Fernandes, Tânia; Chiu, Anna; Raybardhan, Sumit; Science, Michelle; Fernando, Eshan; Bell, Chaim M.; Morris, Andrew M.

doi:10.1016/j.jcmg.2015.02.027

Cited by 29 publications

(20 citation statements)

References 24 publications

(26 reference statements)

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“…This finding is consistent with previous estimates of mortality due to SAB IE with reported one‐year mortality rates of up to 43% worldwide, based on recently published data from the International Collaboration on Endocarditis cohort . The poor health status of patients most at risk of acquiring SAB, including individuals with diabetes mellitus, multiple comorbidities, and permanent venous catheters, likely contributes to the high mortality in this patient population . The Kaplan–Meier curve suggests that there is no significant mortality difference at any point throughout the first year, although it suggests that a greater proportion of deaths occur earlier on in patients with IE.…”

Section: Discussionsupporting

confidence: 90%

“…3 The poor health status of patients most at risk of acquiring SAB, including individuals with diabetes mellitus, multiple comorbidities, and permanent venous catheters, likely contributes to the high mortality in this patient population. 19 The Kaplan-Meier curve suggests that there is no significant mortality difference at any point throughout the first year, although it suggests that a greater proportion of deaths occur earlier on in patients with IE. Additionally, there was no mortality difference between patients who were diagnosed with IE on the first TTE vs on subsequent echocardiographic studies.…”

Section: Discussionmentioning

confidence: 99%

“…In SAB, the sensitivity of TTE is 24%–58% with a specificity of 99%–100% for the diagnosis of IE . The sensitivity of TTE is lower in patients with high‐risk clinical features including the presence of prosthetic valves, cardiac implantable electronic devices, community‐acquired SAB, intravenous drug use, and/or bacteremia persistent for >72 hours . Recent studies have identified, however, that in patients without high‐risk features, a normal TTE study has adequate sensitivity to rule out IE in SAB …”

Section: Discussionmentioning

confidence: 99%

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Clinical utility of echocardiography for the diagnosis of native valve infective endocarditis in Staphylococcus aureus bacteremia

et al. 2019

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Background The incidence of Staphylococcus aureus infective endocarditis (IE) is steadily rising due to advances in health care delivery. Routine echocardiography is essential in the management of Staphylococcus aureus bacteremia (SAB). The aim of this retrospective cohort study was to characterize the real‐world use of echocardiography in adult patients with SAB and native valve S aureus IE. Methods Using an academic hospital microbiological database, all cases of SAB in adults between 2010 and 2016 were identified. Demographic, echocardiographic, and clinical features were recorded. Results A total of 738 episodes of SAB were identified, of which 504 (68%) patients underwent transthoracic echocardiography (TTE) within 30 days. Of 73 patients with definite IE, 46 (63%) patients had definite IE diagnosed on the initial TTE. An additional 14 (19%) patients had definite IE diagnosed on repeat TTE, 6 (8%) on transesophageal echocardiography (TEE), and 7 (10%) were diagnosed without fulfilling Duke echocardiographic criteria. The yield of repeat TTE was comparable to that of TEE for identifying new vegetations not identified on the initial TTE (17% vs 21%, P = .78). Conclusions Most cases of IE in SAB were identified using TTE alone, with repeat TTE improving the diagnostic yield in the setting of clinical decompensation.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical utility of echocardiography for the diagnosis of native valve infective endocarditis in Staphylococcus aureus bacteremia

et al. 2019

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“…TTE may be adequate in a carefully selected minority of patients who do not have a permanent intracardiac device, have sterile follow-up blood cultures within 4 days after the initial set, are not haemodialysis dependent, have nosocomial acquisition of bacteraemia, do not have secondary foci of infection and do not have clinical signs of IE 105 . To differentiate patients with S. aureus bacteraemia who are at high risk of IE from those at low risk, several scoring systems have been proposed 106–110 although none has been prospectively evaluated.…”

Section: Diagnosis Screening and Preventionmentioning

confidence: 99%

Infective endocarditis

Holland

Baddour

Bayer³

et al. 2016

Nat Rev Dis Primers

342

278

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Infective endocarditis (IE) is a rare, life-threatening disease that has long-lasting effects even among patients who survive and are cured. IE disproportionately affects those with underlying structural heart disease and is increasingly associated with healthcare contact, particularly in patients who have intravascular prosthetic material. In the setting of bacteraemia with a pathogenic organism, an infected vegetation may form as the end result of complex interactions between invading microorganisms and the host immune system. Once established, IE can involve almost any organ system in the body. The diagnosis of IE may be difficult to establish and a strategy that combines clinical, microbiological and echocardiography results has been codified in the modified Duke criteria. In cases of blood culture-negative IE, the diagnosis may be especially challenging and novel microbiological and imaging techniques have been developed to establish its presence. Once diagnosed, IE is best managed by a multidisciplinary team with expertise in infectious diseases, cardiology and cardiac surgery. Antibiotic prophylaxis for the prevention of IE remains controversial. Efforts to develop a vaccine targeting common bacterial causes of IE are ongoing, but have not yet yielded a commercially available product.

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“…28–34 The present study suggests that simple criteria based on TTE findings can be applied across a variety of infectious organisms. In contrast to prior investigators, we chose to examine the diagnostic characteristics of TTE in patients with native valves only.…”

Section: Discussionmentioning

confidence: 87%

An Approach to Improve the Negative Predictive Value and Clinical Utility of Transthoracic Echocardiography in Suspected Native Valve Infective Endocarditis

Sivak

Vora

Návar

et al. 2016

Journal of the American Society of Echocardiography

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Background In patients with suspected native valve infective endocarditis (IE), current guidelines recommend an initial transthoracic echocardiogram (TTE) followed by a transesophageal echocardiogram (TEE) if clinical suspicion remains. The guidelines do not account for quality of the initial TTE or other findings that may alter the study’s diagnostic characteristics. This may lead to unnecessary TEE procedures where the initial TTE was sufficient to rule out vegetation. Methods Patients with suspected native valve endocarditis that underwent a TTE followed by a TEE within 7 days between 1/1/2007 and 2/28/2014 were included. A negative TTE for vegetation was defined by either the standard approach (at least possible vegetation seen on TTE), or by applying a set of strict negative criteria incorporating other findings on TTE. Using TEE as the gold standard for presence of vegetation, the diagnostic performance of the two TTE approaches were compared. Results In total, 790 TTE/TEE pairs were identified. With the standard approach, 671 of the TTEs were negative, compared to 107 negative studies using the strict negative approach. The sensitivity and negative predictive value (NPV) of TTE for detecting vegetation were substantially improved using the strict negative approach (sensitivity: 98% [95% C.I. 95–99%] vs. 39% [95% C.I. 31%–47%], NPV: 97% [95% C.I. 92–99%] vs. 86% [95% C.I. 83–88%]). Conclusions The ability for TTE to exclude vegetation in patients is excellent when strict criteria for a negative study are applied. In low to intermediate risk patients with a strict negative TTE, follow up TEE may be unnecessary.

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

Abstract: A normal TTE ruled out IE in patients without community-acquired SAB, high-risk cardiac conditions, and intravenous drug use. This study provides evidence that clinical risk stratification combined with a normal TTE may be adequate to rule out IE in most patients with SAB.

Cited by 29 publications

References 24 publications

Clinical utility of echocardiography for the diagnosis of native valve infective endocarditis in Staphylococcus aureus bacteremia

Clinical utility of echocardiography for the diagnosis of native valve infective endocarditis in Staphylococcus aureus bacteremia

Infective endocarditis

An Approach to Improve the Negative Predictive Value and Clinical Utility of Transthoracic Echocardiography in Suspected Native Valve Infective Endocarditis

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