Comparing Echocardiographic Modalities in Native-Valve Infective Endocarditis Due to Methicillin-Resistant...

Area of Science:

• Cardiology
• Infectious Diseases
• Medical Imaging

Background:

• Methicillin-resistant Staphylococcus aureus (MRSA) infective endocarditis (IE) carries high morbidity and mortality.
• Transesophageal echocardiogram (TEE) is preferred over transthoracic echocardiogram (TTE) for IE diagnosis.
• Management of IE in people who inject drugs (PWID) often involves prolonged antibiotics, with valve replacement being controversial due to reinfection risks.

Purpose of the Study:

• To evaluate if sequential TEE after TTE in PWID with MRSA native-valve IE alters the management plan.
• To assess the diagnostic yield of TEE in MRSA IE patients with initially negative TTE findings.

Main Methods:

• Retrospective cohort study of adult PWID with definite MRSA IE (2013-2019).
• Review of echocardiographic reports (TTE and TEE) and patient management plans.
• Analysis of vegetation detection rates and impact on treatment decisions.

Main Results:

• Of 126 patients, 121 had TTE; 57% showed vegetations.
• In 52 patients with negative TTE, 44 had TEE, revealing vegetations in 53%.
• Only two patients (1.6%) had a management change solely due to sequential TEE findings.

Conclusions:

• Sequential TEE after TTE in PWID with MRSA native IE infrequently changes management.
• The decision to perform TEE in this population should be individualized.
• Larger studies are necessary to clarify the role of TEE in MRSA IE among PWID.