Comparative Sensitivity of Transthoracic and Transesophageal Echocardiography in Diagnosis of Infective Endocarditis Among Veterans With Staphylococcus aureus Bacteremia

Poorani Sekar; James R. Johnson; Joseph R. Thurn; Dimitri M. Drekonja; Vicki A. Morrison; Yellapragada Chandrashekhar; Selcuk Adabag; Michael A. Kuskowski; Gregory A. Filice

doi:10.1093/ofid/ofx035

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Comparative Sensitivity of Transthoracic and Transesophageal Echocardiography in Diagnosis of Infective Endocarditis Among Veterans With Staphylococcus aureus Bacteremia

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Comparative Sensitivity of Transthoracic and Transesophageal Echocardiography in Diagnosis of Infective Endocarditis Among Veterans With Staphylococcus aureus Bacteremia

Poorani Sekar, James R. Johnson, Joseph R. Thurn, Dimitri M. Drekonja, Vicki A. Morrison, Yellapragada Chandrashekhar, Selcuk Adabag, Michael A. Kuskowski and Gregory A. Filice

Open forum infectious diseases, Vol.4(2), pp.ofx035-ofx035

04/01/2017

DOI: 10.1093/ofid/ofx035

PMCID: PMC5407216

PMID: 28470017

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Abstract

Abstract Background Echocardiography is fundamental for diagnosing infective endocarditis (IE) in patients with Staphylococcus aureus bacteremia (SAB), but whether all such patients require transesophageal echocardiography (TEE) is controversial. Methods We identified SAB cases between February 2008 and April 2012. We compared sensitivity and specificity of transthoracic echocardiography (TTE) and TEE for evidence of IE, and we determined impacts of IE risk factors and TTE image quality on comparative sensitivities of TTE and TEE and their impact on clinical decision making. Results Of 215 evaluable SAB cases, 193 (90%) had TTE and 130 (60%) had TEE. In 119 cases with both tests, IE was diagnosed in 29 (24%), for whom endocardial involvement was evident in 25 (86%) by TEE, vs only 6 (21%) by TTE (P < .001). Transesophageal echocardiography was more sensitive than TTE regardless of risk factors. Even among the 66 cases with adequate or better quality TTE images, sensitivity was only 4 of 17 (24%) for TTE, vs 16 of 17 (94%) for TEE (P < .001). Among 130 patients with TEE, the TEE results, alone or with TTE results, influenced treatment duration in 56 (43%) cases and led to valve surgery in at least 4 (6%). It is notable that, despite vigorous efforts to obtain both tests routinely, TEE was not done in 86 cases (40%) for various reasons, including pathophysiological contraindications (14%), patient refusal or other patient-related factors (16%), and provider declination or system issues (10%). Conclusions Patients with SAB should undergo TEE when possible to detect evidence for IE, especially if the results might affect management.

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Title: Subtitle: Comparative Sensitivity of Transthoracic and Transesophageal Echocardiography in Diagnosis of Infective Endocarditis Among Veterans With Staphylococcus aureus Bacteremia
Creators: Poorani Sekar - University of Minnesota
James R. Johnson - United States Department of Veterans Affairs
Joseph R. Thurn - University of Minnesota
Dimitri M. Drekonja - University of Minnesota
Vicki A. Morrison - University of Minnesota
Yellapragada Chandrashekhar - University of Minnesota
Selcuk Adabag - University of Minnesota
Michael A. Kuskowski - University of Minnesota
Gregory A. Filice - United States Department of Veterans Affairs
Resource Type: Journal article
Publication Details: Open forum infectious diseases, Vol.4(2), pp.ofx035-ofx035
DOI: 10.1093/ofid/ofx035
PMID: 28470017
PMCID: PMC5407216
NLM abbreviation: Open Forum Infect Dis
ISSN: 2328-8957
eISSN: 2328-8957
Publisher: Oxford University Press
Language: English
Date published: 04/01/2017
Academic Unit: Infectious Diseases; Internal Medicine
Record Identifier: 9984359912002771

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