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The role of transthoracic echocardiography in excluding left sided infective endocarditis in Staphylococcus aureus

S J Van Hal1, G Mathur, J Kelly

  • 1The Prince of Wales Hospital, Randwick, NSW, Australia. vanhal@iprimus.com.au

The Journal of Infection
|October 19, 2005
PubMed

Insights

Transesophageal echocardiography may not always be needed for Staphylococcus aureus bacteremia patients. Normal transthoracic echocardiograms significantly lower infective endocarditis probability, especially without emboli.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Diagnostics

Background:

  • Staphylococcus aureus bacteremia poses a risk for infective endocarditis.
  • Transesophageal echocardiography is typically recommended to rule out infective endocarditis in these cases.

Purpose of the Study:

  • To evaluate the diagnostic utility of transthoracic echocardiography in excluding infective endocarditis in patients with Staphylococcus aureus bacteremia.
  • To identify clinical factors that can reduce the need for transesophageal echocardiography.

Main Methods:

  • Retrospective analysis of patients with Staphylococcus aureus bacteremia.
  • Assessment of echocardiographic findings (transthoracic echocardiogram) and clinical data.
  • Correlation of echocardiographic results with the incidence of infective endocarditis.

Main Results:

  • Normal to trivial valvular regurgitation on transthoracic echocardiogram significantly decreased the probability of infective endocarditis.
  • In the absence of embolic phenomena, the likelihood of infective endocarditis was less than 2%.
  • Echocardiogram performance more than 5 days post-bacteremia further reduced this probability.

Conclusions:

  • Transthoracic echocardiography findings can effectively stratify risk for infective endocarditis in Staphylococcus aureus bacteremia.
  • Transesophageal echocardiography may not be necessary in all patients, particularly those with normal transthoracic echocardiogram results and no embolic events.

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