1058. Echocardiograms in Staphylococcus aureus Bacteremia (SAB): Lack of Benefit of Testing in Uncomplicated SAB According to Current Practice Guidelines
Session: Poster Abstract Session: Guidelines in Clinical Practice
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • Khatib IDSA-11-SAB-ECHO-Poster 10-6-11.pdf (52.0 kB)
  • Background: 

    Current practice guidelines for the treatment of SAB stratify treatment duration according to the likelihood of complications and advocate echocardiogram (ECHO), preferably trans-esophageal (TEE), in all patients with SAB. The benefit of ECHOs in uncomplicated SAB has not been validated.

    Methods: 

    Retrospective analysis of the frequency of trans-thoracic ECHO (TTE) and TEE performance in hospitalized adults with SAB between 7/2008-12/2009, the reason for performance and the results.  ECHOs were ordered according to the managing physicians’ preference. SAB cases with ECHOs were stratified into persistent SAB (PER; ≥3 d), relapse (REL), the presence of intracardiac prosthetic devices (DEV), clinical findings consistent with endocarditis (CLIN) and uncomplicated (UC) SAB (≤ 2 d and without distant seeding).

    Results: 

    We encountered 296 SAB cases, 54 were excluded because of death/transfer/discharge within 48 h of SAB (n=24), suspected contamination (n=11) and mixed bacteremia (n=19). Among the remainder, TTE was performed within 0-19 d (median=2) in 102 (42.1%) cases and TEE was performed within 0-22 d (median=6) in 60 (24.8%) instances. TTE was performed in PER/REL, DEV, CLIN, and UC-SAB in 51 (50.0%), 8 (7.8%), 4 (3.9%), and 39 (38.2%) cases, respectively. TEE was performed in PER/REL, DEV, CLIN, and UC-SAB in 38 (63.3%), 5 (8.3%), 5 (8.3%) and 12 (20.0%), respectively. ECHO results were stratified according to the SAB type (table). ALL TTE and 91.7% of TEE performed in UC-SAB were negative. TEE was positive in 10/44 (22.7%) cases with negative TTE.

    ECHO

    Type of S. aureus bacteremia with Echocardiograms

    PER/REL

    DEVICE

    CLINICAL

    UC-SAB

    TTE: n

    51

    8

    4

    39

      N Positive (%)

    6 (11.8)

    1/8 (12.5)

    0/4

    1 a /39

    TEE n

    38

    5

    5

    12

      N Positive (%)

    8 (21.1)

    3 (60.0)

    2 (40.0)

    1 (8.3)

     PER: persistent; REL; relapse; uncomplicated SAB (£3days without distant seeding); a: considered false positive (negative TEE).

    Conclusion: 

    TEE in uncomplicated SAB is rarely positive and is probably not cost-effective. TEE should be limited to subsets with persistent SAB, relapse, cardiac devices and suspected endocarditis based on clinical findings. TTE was rarely helpful. These findings do not validate the new practice guidelines for TEE in all cases with SAB.


    Subject Category: J. Clinical practice issues

    Riad Khatib, MD and Mamta Sharma, MD, St. John Hospital and Medical Center, Grosse Pointe Woods, MI

    Disclosures:

    R. Khatib, None

    M. Sharma, None

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