1. Forgoing transesophageal echocardiogram in selected patients with complicated Staphylococcus aureus bacteremia.
- Author
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Lam JC, Gregson DB, Somayaji R, Robinson S, Conly JM, Welikovitch L, and Parkins MD
- Subjects
- Algorithms, Anti-Bacterial Agents therapeutic use, Bacteremia drug therapy, Bacteremia surgery, Canada epidemiology, Echocardiography, Endocarditis, Bacterial drug therapy, Endocarditis, Bacterial surgery, Humans, Patient Selection, Practice Guidelines as Topic, Retrospective Studies, Sensitivity and Specificity, Staphylococcal Infections drug therapy, Staphylococcal Infections surgery, Staphylococcus aureus drug effects, Bacteremia diagnostic imaging, Echocardiography, Transesophageal, Endocarditis, Bacterial diagnostic imaging, Staphylococcal Infections diagnostic imaging
- Abstract
Infective endocarditis (IE) has been increasingly recognized as an important complication of Staphylococcus aureus bacteremia (SAB), leading to a low threshold for echocardiography and extended treatment with anti-staphylococcal agents. However, outside of IE, many indications for prolonged anti-staphylococcal therapy courses are present. We sought to determine the frequency in which findings from a transesophageal echocardiogram (TEE) changed clinical SAB management in a large Canadian health region. Residents (> 18 years) with SAB from 2012 to 2014 who underwent transthoracic echocardiogram (TTE) and TEE were assessed. Patients potentially benefiting from an extended course of anti-staphylococcal agents were defined a priori. Patient demographics, treatment (including surgical), and clinical outcomes were extracted and evaluated. Of the 705 episodes of SAB that underwent a screening echocardiogram, 203 episodes underwent both a TTE and TEE, of which 92.1% (187/203) contained an a priori indication for extended anti-staphylococcal therapy. Regardless of TEE results, actual duration of therapy did not differ in SAB episodes that had ≥ 1 extended anti-staphylococcal therapy criteria (36.7 days, IQR 23.4-48.6 vs. 43.8 days, IQR 33.3-49.5, p = 0.17). Additionally, there were no cases in which TEE was utilized as the sole reason to shorten duration of therapy or proceed to surgery for those with SAB. Routine performance of TEE may be unnecessary in all SAB as many patients have pre-existing indications for extended anti-staphylococcal therapy independent of TEE findings. An algorithm to selectively identify cases of SAB that would benefit from TEE can reduce resource and equipment expenditure and patient risks associated with TEE.
- Published
- 2021
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