Related Experiment Videos
Perivalvular abscesses due to Staphylococcus aureus endocarditis comparison with Streptococcus viridans endocarditis
1Division of Cardiovascular Disease and Internal Medicine, Srinagarind Hospital, Khon Kaen University, Thailand.
Background:
Perivalvular abscesses are major complications of infective endocarditis (IE). The prevalence and best approach to detection of this complication in Staphylococcus aureus (SA) in comparison to Streptococcus viridans (SV) IE is unclear.
Method:
Among 243 consecutive episodes of IE diagnosed using the Duke criteria, who underwent either transthoracic (TTE) or transesophageal echocardiography (TEE) at the Mayo Clinic between 1988 and 1993, there were 64 cases of SV and 61 of SA IE. Comparison of TTE and TEE detection of abscesses were restricted to patients with either surgical or autopsy examination and both TTE and TEE were performed.
Results:
Prosthetic valve and valve repair were significantly higher in SA compared to SV IE (46 vs 23%, P = 0.008). The prevalence of abscesses was higher in SA compared to SV IE (42 vs 14%, P = 0.08). 1 (10%) of abscess detected by TTE in SA compared to 1 (50%) in SV IE and 6 (60%) by TEE in SA and 1 (50%) in SV IE. Incremental value of TEE vs TTE was higher in SA 5/24 (21%) than in SV IE 0/14 (0%) P = 0.067. Hospital mortality was significantly higher in SA than SV IE (13 vs 2%, P = 0.013).
Conclusion:
Patients diagnosed with IE and those with SA 1) presented more often with prosthetic valve IE, 2) developed more perivalvular abscesses, and 3) had a higher in hospital mortality than those with SV. Incremental value of TEE was higher in SA than in SV IE, 4) therefore, had a stringent requirement for initial and repeated TEE to detect this ominous complication of IE.
Insights
Staphylococcus aureus infective endocarditis (IE) cases show higher rates of perivalvular abscesses and mortality than Streptococcus viridans IE. Transesophageal echocardiography (TEE) offers greater value in detecting abscesses in S. aureus IE.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- Perivalvular abscesses are serious complications of infective endocarditis (IE).
- The comparative prevalence and detection methods for abscesses in Staphylococcus aureus (SA) IE versus Streptococcus viridans (SV) IE are not well-defined.
Purpose of the Study:
- To compare the prevalence of perivalvular abscesses in SA IE versus SV IE.
- To evaluate the diagnostic performance of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in detecting these abscesses.
Main Methods:
- A retrospective analysis of 243 IE episodes diagnosed by Duke criteria between 1988 and 1993.
- Comparison of TTE and TEE for abscess detection in patients who underwent both imaging modalities and had surgical or autopsy confirmation.
Main Results:
- SA IE cases had higher rates of prosthetic valve involvement and perivalvular abscesses compared to SV IE.
- TEE demonstrated a higher incremental value in detecting abscesses in SA IE (21%) than in SV IE (0%).
- Hospital mortality was significantly higher in SA IE (13%) compared to SV IE (2%).
Conclusions:
- Staphylococcus aureus IE is associated with a greater incidence of perivalvular abscesses and higher in-hospital mortality than Streptococcus viridans IE.
- Transesophageal echocardiography is crucial for the accurate detection of perivalvular abscesses in S. aureus IE, necessitating its early and repeated use.