1273. Sensitivity and Specificity of Transthoracic Echocardiography (TTE) and Transesophageal Echocardiography (TEE) for the Diagnosis of Infective Endocarditis  (IE) in Patients with Staphylococcus aureus Bacteremia (SAB) at the Minneapolis Veterans Administration Health Care System (MVAHCS)
Session: Poster Abstract Session: Bacteremia and Endocarditis
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C

Background:

IE occurs in ~15% of patients with SAB.  In previous studies, TEE has been more sensitive than TTE for diagnosis of IE.  Still, some experts recommend TTE because of convenience, lack of complications, and lower costs, especially in patients without risk factors for IE.  We determined sensitivity and specificity of TTE and TEE in MVAHCS patients with SAB.

Methods:

From February 2008 to April 2012, infectious diseases and cardiology recommended both TTE and TEE for patients with SAB.  We identified cases with S. aureus in blood cultures and extracted information from medical records.  Endocarditis was defined by modified Duke criteria.

Results:

Of 218 evaluable cases, TTE and TEE were both done in 119.  Of these, 31 had definite IE, and 14 had possible IE. Test characteristics for diagnosis of definite IE are shown in Table 1. 

Sensitivity and specificity for TTE and TEE for definite IE in patients with SAB and risk factors for IE are shown in Table 2

Of 195 patients who had TTE ± TEE, sensitivity of TTE was 13/38 (34.2%), specificity was 156/157 (99.4%), PPV was 13/14 (92.9%), and NPV was 156/181 (86.2%). 

Conclusion:  

TEE was 3.6 fold more sensitive than TTE for diagnosis of IE among the 119 cases with both TTE and TEE.  TEE was more sensitive with or without risk factors.  We concluded that TEE should be the echocardiogram of choice in patients with S. aureus bacteremia.   

Poorani Sekar, MD1,2, Michael A. Kuskowski, PhD3, Selcuk Adabag, MD, MS4,5, Stefan Bertog, MD, FACC, FSCAI4,5, Y.S. Chandrashekhar, MD4,5 and Gregory A. Filice, MD1,2, (1)Division of Infectious Disease, University of Minnesota, Minneapolis, MN, (2)Section of Infectious Disease, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, MN, (3)Geriatric Research Education and Clinucal Center (GRECC), Minneapolis Veterans Affairs Healthcare System, Minneapolis, MN, (4)Division of Cardiology, Minneapolis Veterans Affairs Healthcare System, Minneapolis, MN, (5)Division of Cardiology, University of Minnesota, Minneapolis, MN

Disclosures:

P. Sekar, None

M. A. Kuskowski, None

S. Adabag, None

S. Bertog, None

Y. S. Chandrashekhar, None

G. A. Filice, None

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