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Chong A, Stanton T, Taylor A, Prior D, La Gerche A, Anderson B, Scalia G, Cooke J, Dahiya A, To A, Davis M, Mottram P, Moir S, Playford D, Mahadavan D, Thomas L, Wahi S. 2024 CSANZ Position Statement on Indications, Assessment and Monitoring of Structural and Valvular Heart Disease With Transthoracic Echocardiography in Adults. Heart Lung Circ 2024; 33:773-827. [PMID: 38749800 DOI: 10.1016/j.hlc.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 08/22/2023] [Accepted: 11/01/2023] [Indexed: 06/25/2024]
Abstract
Transthoracic echocardiography (TTE) is the most widely available and utilised imaging modality for the screening, diagnosis, and serial monitoring of all abnormalities related to cardiac structure or function. The primary objectives of this document are to provide (1) a guiding framework for treating clinicians of the acceptable indications for the initial and serial TTE assessments of the commonly encountered cardiovascular conditions in adults, and (2) the minimum required standard for TTE examinations and reporting for imaging service providers. The main areas covered within this Position Statement pertain to the TTE assessment of the left and right ventricles, valvular heart diseases, pericardial diseases, aortic diseases, infective endocarditis, cardiac masses, pulmonary hypertension, and cardiovascular diseases associated with cancer treatments or cardio-oncology. Facilitating the optimal use and performance of high quality TTEs will prevent the over or under-utilisation of this resource and unnecessary downstream testing due to suboptimal or incomplete studies.
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Affiliation(s)
- Adrian Chong
- Department of Cardiology, Princess Alexandra Hospital, Mater Hospital Brisbane, University of Queensland, Brisbane, Qld, Australia
| | - Tony Stanton
- Sunshine Coast University Hospital, School of Health University of Sunshine Coast, School of Medicine and Dentistry Griffith University, Birtinya, Qld, Australia
| | - Andrew Taylor
- Department of Cardiology, Royal Melbourne Hospital, Alfred Hospital, Melbourne, Vic, Australia
| | - David Prior
- Albury Wodonga Health, Albury, NSW, Australia
| | - Andre La Gerche
- St Vincent's Hospital, Baker Heart and Diabetes Institute, University of Melbourne, Melbourne, Vic, Australia
| | - Bonita Anderson
- Cardiac Sciences Unit, The Prince Charles Hospital, Queensland University of Technology, Brisbane, Qld, Australia
| | - Gregory Scalia
- The Prince Charles Hospital, University of Queensland, Brisbane, Qld, Australia
| | - Jennifer Cooke
- Department of Cardiology, Eastern Health, Monash University, Melbourne, Vic, Australia
| | - Arun Dahiya
- Department of Cardiology, Princess Alexandra Hospital, Logan Hospital, Griffith University, Brisbane, Qld, Australia
| | - Andrew To
- Department of Cardiology, Health New Zealand Waitemata, Auckland, New Zealand
| | | | - Philip Mottram
- Victorian Heart Institute, Monash University, Melbourne, Vic, Australia
| | - Stuart Moir
- Victorian Heart Institute, Monash University, Melbourne, Vic, Australia
| | | | - Devan Mahadavan
- Department of Cardiology, Queen Elizabeth Hospital, Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Liza Thomas
- Department of Cardiology, Westmead Hospital, Westmead Clinical School University of Sydney, South West Clinical School University of New South Wales, Sydney, NSW, Australia
| | - Sudhir Wahi
- Department of Cardiology, Princess Alexandra Hospital, University of Queensland, Brisbane, Qld, Australia.
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2
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Petersen JK, Østergaard L, Fosbøl EL. Role of echocardiography in the diagnosis and clinical management of infective endocarditis. Indian J Thorac Cardiovasc Surg 2024; 40:16-28. [PMID: 38827556 PMCID: PMC11139831 DOI: 10.1007/s12055-023-01668-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 06/04/2024] Open
Abstract
Infective endocarditis (IE) is a deadly disease, constituting both diagnostic and treatment challenges. A positive outcome requires rapid and accurate diagnosis, and for that, echocardiography unequivocally remains the cornerstone. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) have complementary roles and have been markedly improved during the last decades. The transthoracic modality is the recommended first-line approach but may only be sufficient in patients where the probability of IE is low and/or with clear acoustic windows, especially in patients with right-sided IE. The transesophageal modality is superior to TTE in most aspects and is recommended for all other patients. Both TTE and TEE may delineate vegetation location and size, assess for paravalvular extension of infection, and have the added advantage of defining the hemodynamic effects of valvular or device infection. However, echocardiography still has significant limitations, and novel imaging techniques are increasingly being exploited to improve diagnostic potential. Cardiac computed tomography (CT) performs better than TEE in the detection of abscess or pseudoaneurysm, while magnetic resonance imaging (MRI) has limited value in the diagnostic phase of IE but adds knowledge to the evaluation of extracardiac events. Nuclear molecular techniques are evolving as key supplementary methods in difficult-to-diagnose cases. Although newer imaging modalities are undergoing preliminary evaluation and multimodal imaging will play an increasing role in IE, echocardiography will continue to be pivotal in patients with IE for the foreseeable future.
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Affiliation(s)
- Jeppe Kofoed Petersen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Lauge Østergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Emil Loldrup Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
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Thottacherry E, Cortés-Penfield NW. Evidence of clinical impact supports a new petition for Medicare coverage of 18F-FDG-PET/CT in the evaluation of Staphylococcus aureus bacteremia: a focused literature review and call to action. Clin Infect Dis 2022; 75:1457-1461. [PMID: 35535794 DOI: 10.1093/cid/ciac363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Indexed: 12/13/2022] Open
Abstract
Staphylococcus aureus bacteremia (SAB) causes considerable morbidity and mortality and requires comprehensive assessment for metastatic infection. The roles of routine imaging beyond echocardiography in SAB, including 18F-FDG-PET/CT, remain contentious. We performed a literature review of studies reporting impact of 18F-FDG-PET/CT on the clinical management or outcomes of SAB published through 3/1/2022. We identified seven observational studies, in which 18F-FDG-PET/CT frequently identified metastatic foci of infection, revealed foci undetected by prior investigations, led to additional source control procedures, and was associated with fewer infection relapses and lower mortality. Calculated numbers needed to treat (NNTs) for receipt of 18F-FDG-PET/CT were 7-9 to change antimicrobial therapy, 10-27 to lead to an additional source control procedure, and 4-8 to prevent death. These data are comparable to the evidence for clinical impact of other diagnostic modalities accepted as standard of care in SAB, and form a compelling basis for advocacy to expand access to 18F-FDG-PET/CT.
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Affiliation(s)
- Elizabeth Thottacherry
- Division of Infectious Diseases, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
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Marcos-Garces V, Gabaldon-Perez A, Merenciano-Gonzalez H, Soler M, Lorenzo-Hernandez M, Nuñez-Marin G, de la Espriella R, Bonanad C, Nuñez J, Chorro FJ, Bodi V, Santas E. Applicability of Echocardiographic Strict Negative Criteria for Suspected Infective Endocarditis. Am J Cardiol 2022; 162:156-162. [PMID: 34728063 DOI: 10.1016/j.amjcard.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022]
Abstract
Echocardiography is the cornerstone imaging technique in the diagnosis of infective endocarditis (IE) but is often misused in clinical practice. Recently, strict negative criteria have been proposed to avoid unnecessary follow-up echocardiograms. We aimed to evaluate the use of echocardiography in real-world clinical daily practice and the usefulness of these criteria in the diagnosis of IE. We retrospectively retrieved every echocardiogram performed in our center for suspected IE between 2014 and 2018, including 905 transthoracic echocardiograms (TTEs). Of these, 451 (49.8%) fulfilled the strict negative criteria (group 1). In this group, IE was seldom diagnosed (n = 4, 0.9%). In 338 patients (37.4%) no signs of IE were evident, but they did not fulfill the strict negative criteria (group 2). A follow-up echocardiogram and definitive diagnosis of IE were more frequent (n = 48, 14.2% and n = 20, 5.9%). Finally, in 116 patients (12.8%) the initial TTE showed typical or suggestive signs of IE, in whom the diagnosis was confirmed in 48 patients (41.4%). A definitive diagnosis of IE was established in a minority of the study population (n = 72, 8%). Only 1 readmission for underdiagnosis of IE was noted on group 2. We conclude that in a real-life setting only a minority of patients in whom IE was suspected had a definitive diagnosis. An initial TTE for suspected IE fulfilling the strict negative criteria predicts both a low probability of requesting a follow-up study and of a definitive diagnosis of IE.
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Affiliation(s)
- Victor Marcos-Garces
- Department of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain; INCLIVA Health Research Institute, Valencia, Spain
| | - Ana Gabaldon-Perez
- Department of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | | | - Meritxell Soler
- Department of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | | | - Gonzalo Nuñez-Marin
- Department of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Rafael de la Espriella
- Department of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain; INCLIVA Health Research Institute, Valencia, Spain
| | - Clara Bonanad
- Department of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain; INCLIVA Health Research Institute, Valencia, Spain; Centro de Investigación Biomédica en Red-Cardiovascular (CIBER-CV), Madrid, Spain
| | - Julio Nuñez
- Department of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain; INCLIVA Health Research Institute, Valencia, Spain; Centro de Investigación Biomédica en Red-Cardiovascular (CIBER-CV), Madrid, Spain; Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
| | - Francisco Javier Chorro
- Department of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain; INCLIVA Health Research Institute, Valencia, Spain; Centro de Investigación Biomédica en Red-Cardiovascular (CIBER-CV), Madrid, Spain; Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
| | - Vicente Bodi
- Department of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain; INCLIVA Health Research Institute, Valencia, Spain; Centro de Investigación Biomédica en Red-Cardiovascular (CIBER-CV), Madrid, Spain; Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
| | - Enrique Santas
- Department of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain; INCLIVA Health Research Institute, Valencia, Spain.
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Mun SJ, Kim SH, Huh K, Cho SY, Kang CI, Chung DR, Peck KR. Role of echocardiography in uncomplicated Staphylococcus aureus catheter-related bloodstream infections. Medicine (Baltimore) 2021; 100:e25679. [PMID: 33950948 PMCID: PMC8104220 DOI: 10.1097/md.0000000000025679] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/06/2021] [Indexed: 01/04/2023] Open
Abstract
Uncomplicated bacteremia and catheter-related bloodstream infection (CRBSI) are frequently suggested as factors associated with low risk of infective endocarditis in Staphylococcus aureus bacteremia (SAB). Nevertheless, guidelines recommend that echocardiography in all patients with SAB. We evaluated the effects of echocardiography on patient outcomes. Patients with uncomplicated S. aureus CRBSI were retrospectively identified between January 2013 and June 2018 at a 1950-bed, tertiary-care university hospital. Treatment failure was defined as any case of relapse or all-cause death within 90 days. Of 890 SAB patients, 95 with uncomplicated S. aureus CRBSI were included. Thirty-two patients underwent echocardiography within 30 days of their first positive blood culture. Two patients who underwent echocardiography revealed right-sided infective endocarditis. One patient who did not undergo echocardiography experienced recurrent SAB (peripheral CRBSI) 85 days after his first positive blood culture. There were no SAB-related deaths. The Kaplan-Meier curves of treatment failure showed no significant differences between patients who did and did not undergo echocardiography (P = .77). In multivariable analysis, risk factors for treatment failure were liver cirrhosis (hazard ratio: 9.60; 95% confidence interval: 2.13-43.33; P = .003) and other prostheses (hazard ratio: 63.79; 95% confidence interval: 5.05-805.40; P = .001). This study did not verify the putative association between treatment failure and implementation of echocardiography in patients with uncomplicated S. aureus CRBSI. Given the low observed rates of adverse outcomes, routine echocardiography might not be obligatory and could be performed on an individual basis.
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Affiliation(s)
- Seok Jun Mun
- Division of Infectious Diseases, Department of Internal Medicine, Inje University College of Medicine, Inje University Busan Paik Hospital, Busan
| | - Si-Ho Kim
- Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon
| | - Kyungmin Huh
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sun Young Cho
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cheol-In Kang
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Doo Ryeon Chung
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyong Ran Peck
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Amuchastegui T, Hur DJ, Lynn Fillipon NM, Eder MD, Bonomo JA, Kim Y, McNamara RL, Malinis M, Sugeng L. An assessment of transesophageal echocardiography studies rated as rarely appropriate tests for infective endocarditis at an academic medical center. Echocardiography 2019; 36:2070-2077. [PMID: 31705577 DOI: 10.1111/echo.14525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 09/10/2019] [Accepted: 10/13/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Endocardial involvement documented by echocardiography is a major criterion of the modified Duke criteria (MDC) for infective endocarditis (IE). Though transesophageal echocardiography (TEE) is sensitive in the diagnosis of IE, it can be inappropriately used. METHODS This retrospective study included all patients who underwent TEE due to bacteremia, fever, and/or endocarditis in a single, tertiary academic medical center in 2013. Data collected from electronic medical charts were as follows: demographics, history, physical examination, blood cultures, and transthoracic (TTE) and TEE findings. Cases were categorized based on appropriate use criteria (AUC) and MDC. An infectious disease (ID) specialist reviewed cases with rarely appropriate TEE use. RESULTS In the 194 patients included, 147 (75.8%) were rated as appropriate, 36 (18.6%) rarely appropriate, and 11 (5.6%) uncertain. Of the 36 with rarely appropriate TEEs, using MDC 31 (86%) were rejected and 5 (14%) were possible for IE. Retrospective chart review by an ID specialist determined that 10 of these patients warranted TEE due to compelling issues, including immunosuppression or complicated infection. CONCLUSIONS In this retrospective cohort, almost one fifth of cases were rated as rarely appropriate. However, a review of these cases showed that TEE was often pursued when the clinical situation involved immunosuppression or complex infectious process. There remains room for improvement to our screening process for TEE and a need to implement a nuanced educational plan to better precisely identify appropriate cases for TEE usage.
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Affiliation(s)
- Tomas Amuchastegui
- Internal Medicine Service, Hospital Privado Universitario de Córdoba and Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina.,Department of Internal Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
| | - David J Hur
- Section of Cardiovascular Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
| | - Nicole M Lynn Fillipon
- Section of Cardiovascular Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut.,Section of Cardiology, Worcester Medical Center, Worcester, Massachusetts
| | - Maxwell D Eder
- Department of Internal Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
| | - Jason A Bonomo
- Department of Internal Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
| | - Yekaterina Kim
- Section of Cardiovascular Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
| | - Robert L McNamara
- Section of Cardiovascular Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
| | - Maricar Malinis
- Section of Infectious Diseases, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
| | - Lissa Sugeng
- Section of Cardiovascular Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
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Berge A, Kronberg K, Sunnerhagen T, Nilson BHK, Giske CG, Rasmussen M. Risk for Endocarditis in Bacteremia With Streptococcus-Like Bacteria: A Retrospective Population-Based Cohort Study. Open Forum Infect Dis 2019; 6:ofz437. [PMID: 31667201 PMCID: PMC6814282 DOI: 10.1093/ofid/ofz437] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/02/2019] [Indexed: 12/12/2022] Open
Abstract
Background Many genera and species of Streptococcus-like bacteria (SLB) can cause infective endocarditis (IE), but little is known about the epidemiology of and the risk factors for IE in SLB-bacteremia. The aim of the study was to analyze this in a cohort of patients with SLB-bacteremia, focusing on Abiotrophia, Aerococcus, Gemella, and Granulicatella. We also evaluated whether published scoring systems generated for other Gram-positive bacteria known to cause IE (HANDOC for streptococci and NOVA and DENOVA for enterococci) could be used in SLB bacteremia to decide whether transesophageal echocardiography (TEE) could be omitted. Methods Positive blood cultures with SLB were retrieved from population-based registries in Sweden (3.2 million inhabitants), from January 2012 to December 2017. Clinical data were collected from medical records. Risk factors for IE were analyzed and the performances of the scoring systems were calculated. Results The incidence of bacteremia with the 4 SLB genera was 30 episodes/1 000 000 population per year, of which Aerococcus contributed with 18. Among 568 episodes of bacteremia, 32 cases of IE were identified (5.6%). Infective endocarditis was most common in bacteremia with Abiotrophia (4 of 19) followed by Granulicatella (9 of 124), Gemella (6 of 87), and Aerococcus (13 of 338). NOVA had 100% sensitivity to identify IE but a low specificity (15%). For HANDOC and DENOVA, the sensitivities were 97% and 91%, respectively, whereas specificities were 85% and 90%, respectively, and numbers needed to screen were 3.6 and 2.8, respectively. Conclusions Bacteremia with these SLB is relatively rare, and the decision whether TEE should be performed or not could be based on either HANDOC or DENOVA.
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Affiliation(s)
- Andreas Berge
- Unit of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Kronberg
- Department of Clinical Sciences Lund, Division of Infection Medicine, Lund University, Lund, Sweden
| | - Torgny Sunnerhagen
- Department of Clinical Sciences Lund, Division of Infection Medicine, Lund University, Lund, Sweden
| | - Bo H K Nilson
- Department of Laboratory Medicine Lund, Section of Medical Microbiology, Lund, Sweden.,Clinical Microbiology, Labmedicin, Region Skåne, Lund, Sweden
| | - Christian G Giske
- Department of Laboratory Medicine, Karolinska Institutet and Department of Clinical microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Rasmussen
- Department of Clinical Sciences Lund, Division of Infection Medicine, Lund University, Lund, Sweden.,Skåne University Hospital, Division for Infectious Diseases, Lund, Sweden
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8
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Lau L, Wiens EJ, Karlowsky JA, Keynan Y, Jassal DS. Clinical utility of echocardiography for the diagnosis of native valve infective endocarditis in Staphylococcus aureus bacteremia. Echocardiography 2019; 36:1852-1858. [PMID: 31536152 DOI: 10.1111/echo.14480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/27/2019] [Accepted: 08/23/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The incidence of Staphylococcus aureus infective endocarditis (IE) is steadily rising due to advances in health care delivery. Routine echocardiography is essential in the management of Staphylococcus aureus bacteremia (SAB). The aim of this retrospective cohort study was to characterize the real-world use of echocardiography in adult patients with SAB and native valve S aureus IE. METHODS Using an academic hospital microbiological database, all cases of SAB in adults between 2010 and 2016 were identified. Demographic, echocardiographic, and clinical features were recorded. RESULTS A total of 738 episodes of SAB were identified, of which 504 (68%) patients underwent transthoracic echocardiography (TTE) within 30 days. Of 73 patients with definite IE, 46 (63%) patients had definite IE diagnosed on the initial TTE. An additional 14 (19%) patients had definite IE diagnosed on repeat TTE, 6 (8%) on transesophageal echocardiography (TEE), and 7 (10%) were diagnosed without fulfilling Duke echocardiographic criteria. The yield of repeat TTE was comparable to that of TEE for identifying new vegetations not identified on the initial TTE (17% vs 21%, P = .78). CONCLUSIONS Most cases of IE in SAB were identified using TTE alone, with repeat TTE improving the diagnostic yield in the setting of clinical decompensation.
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Affiliation(s)
- Lawrence Lau
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Evan J Wiens
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - James A Karlowsky
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Yoav Keynan
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Section of Infectious Diseases, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Davinder S Jassal
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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9
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Godo S, Kushimoto S. Prosthetic Valve Endocarditis Diagnosed by 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography. Mayo Clin Proc 2019; 94:733-734. [PMID: 30947842 DOI: 10.1016/j.mayocp.2018.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/11/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Shigeo Godo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Emergency and Critical Care Medicine, Tohoku University Hospital, Sendai, Japan.
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Emergency and Critical Care Medicine, Tohoku University Hospital, Sendai, Japan
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10
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Bonzi M, Cernuschi G, Solbiati M, Giusti G, Montano N, Ceriani E. Diagnostic accuracy of transthoracic echocardiography to identify native valve infective endocarditis: a systematic review and meta-analysis. Intern Emerg Med 2018; 13:937-946. [PMID: 29546685 DOI: 10.1007/s11739-018-1831-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 03/09/2018] [Indexed: 01/19/2023]
Abstract
Infective endocarditis (IE) is a serious and potentially life-threatening disease, and accurate diagnosis is essential. We performed a systematic review and meta-analysis to assess the diagnostic accuracy of transthoracic echocardiography (TTE), with transesophageal echocardiography (TEE) as the reference standard, in patients with suspected IE of the native valves. We performed a systematic search in MEDLINE, EMBASE and Cochrane Library searching for studies that enrolled adult patients with suspected native valves IE where data about both TTE and TEE could be extracted. We included 11 studies, for a total of 2209 patients. The overall sensitivity, specificity, negative and positive likelihood ratios (LR) of TTE are 0.71 (95% CI 0.56-0.82), 0.80 (95% CI 0.58-0.92), 0.37 (95% CI 0.20-0.68) and 3.56 (95% CI 1.3-9.72), respectively. The subgroup analyses of the studies considering different cut-off levels show that the strict negative criteria (i.e., managing indeterminate results as positive) have the highest sensitivity and the lowest LR-. On the contrary, when managing indeterminate results as negative (standard criteria), the specificity and LR+ are the highest. We observed no differences between the studies performed with older and more recent technologies. In conclusion, our study results support the use of a negative TTE as a single rule-out test in patients with a low pre-test probability. In selected cases, the use of strict negative criteria might exclude IE in intermediate-risk patients, and a positive TTE might be considered as a single rule-in test with no need for TEE if TEE results would not change the patient's management.
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Affiliation(s)
- Mattia Bonzi
- Internal Medicine Department, Ca' Granda Foundation IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
| | - Giulia Cernuschi
- Internal Medicine Department, Ca' Granda Foundation IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Monica Solbiati
- Internal Medicine Department, Ca' Granda Foundation IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giuliano Giusti
- Department of Paediatric Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Nicola Montano
- Internal Medicine Department, Ca' Granda Foundation IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elisa Ceriani
- Internal Medicine Department, Ca' Granda Foundation IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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11
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Bolhuis K, Bakker LJ, Keijer JT, de Vries PJ. Implementing a hospital-wide protocol for Staphylococcus aureus bacteremia. Eur J Clin Microbiol Infect Dis 2018; 37:1553-1562. [PMID: 29855842 PMCID: PMC6061069 DOI: 10.1007/s10096-018-3284-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/13/2018] [Indexed: 02/06/2023]
Abstract
Staphylococcus aureus bacteraemia (SAB) is associated with high-mortality and complication rates. A multidisciplinary approach is needed to predict, detect and treat complications. In this pre- and post-intervention study, we investigated the effects of a hospital-wide protocol for diagnosis, classification and treatment of SAB. It was hypothesized that complications and endocarditis would be better identified and treated. Medical records of SAB patients admitted in 2011 and 2012 (pre) were analysed. In 2013, a protocol, describing risk factors, diagnostic classification and recommended treatment, was implemented. In 2014 and 2015 (post), SAB patients were followed prospectively. Transthoracic (TTE) or transoesophageal cardiac ultrasound (TEE) was chosen following a decision tree. A resident internal medicine acted as contact person. Pre-intervention, 98 patients were eligible for analysis compared to 85 patients post-intervention. Age and number of risk factors were slightly higher post-intervention; other baseline characteristics were similar. Most SAB-patients were classified as complicated (89 and 82% pre- and post-intervention, respectively). Follow-up blood cultures drawn within 2 days after initiating treatment increased from 51 to 85%. Cardiac ultrasounds increased from 44 to 83% for TTE and 13 to 24% for TEE. Endocarditis was more frequently diagnosed (4 vs. 12%). Additionally, duration of antibiotic therapy increased. The 3-month mortality did not change significantly (33% pre-intervention vs. 35% post-intervention; p > 0.05). Introduction of a hospital-wide protocol for SAB management increased standard of care, created awareness among clinicians to properly classify SAB, search for endocarditis and adapt duration of antibiotic treatment. Mortality did not decrease.
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Affiliation(s)
- K Bolhuis
- Department of Internal Medicine, Academic Medical Center, Meijbergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - L J Bakker
- Department of Medical Microbiology, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ, Hilversum, The Netherlands
| | - J T Keijer
- Department of Cardiology, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ, Hilversum, The Netherlands
| | - P J de Vries
- Department of Internal Medicine, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ, Hilversum, The Netherlands
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Kim IC, Chang S, Hong GR, Lee SH, Lee S, Ha JW, Chang BC, Kim YJ, Shim CY. Comparison of Cardiac Computed Tomography With Transesophageal Echocardiography for Identifying Vegetation and Intracardiac Complications in Patients With Infective Endocarditis in the Era of 3-Dimensional Images. Circ Cardiovasc Imaging 2018; 11:e006986. [DOI: 10.1161/circimaging.117.006986] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 01/26/2018] [Indexed: 02/06/2023]
Affiliation(s)
- In-Cheol Kim
- From the Division of Cardiology, Severance Cardiovascular Hospital (I.-C.K., G.-R.H., J.-W.H., C.Y.S.), Department of Cardiovascular Surgery, Severance Cardiovascular Hospital (S.H.L., S.L., B.-C.C.), and Department of Radiology, Research Institute of Radiological Science, Severance Hospital (S.C., Y.J.K.), Yonsei University College of Medicine; and Division of Cardiology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University (I.-C.K.)
| | - Suyon Chang
- From the Division of Cardiology, Severance Cardiovascular Hospital (I.-C.K., G.-R.H., J.-W.H., C.Y.S.), Department of Cardiovascular Surgery, Severance Cardiovascular Hospital (S.H.L., S.L., B.-C.C.), and Department of Radiology, Research Institute of Radiological Science, Severance Hospital (S.C., Y.J.K.), Yonsei University College of Medicine; and Division of Cardiology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University (I.-C.K.)
| | - Geu-Ru Hong
- From the Division of Cardiology, Severance Cardiovascular Hospital (I.-C.K., G.-R.H., J.-W.H., C.Y.S.), Department of Cardiovascular Surgery, Severance Cardiovascular Hospital (S.H.L., S.L., B.-C.C.), and Department of Radiology, Research Institute of Radiological Science, Severance Hospital (S.C., Y.J.K.), Yonsei University College of Medicine; and Division of Cardiology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University (I.-C.K.)
| | - Seung Hyun Lee
- From the Division of Cardiology, Severance Cardiovascular Hospital (I.-C.K., G.-R.H., J.-W.H., C.Y.S.), Department of Cardiovascular Surgery, Severance Cardiovascular Hospital (S.H.L., S.L., B.-C.C.), and Department of Radiology, Research Institute of Radiological Science, Severance Hospital (S.C., Y.J.K.), Yonsei University College of Medicine; and Division of Cardiology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University (I.-C.K.)
| | - Sak Lee
- From the Division of Cardiology, Severance Cardiovascular Hospital (I.-C.K., G.-R.H., J.-W.H., C.Y.S.), Department of Cardiovascular Surgery, Severance Cardiovascular Hospital (S.H.L., S.L., B.-C.C.), and Department of Radiology, Research Institute of Radiological Science, Severance Hospital (S.C., Y.J.K.), Yonsei University College of Medicine; and Division of Cardiology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University (I.-C.K.)
| | - Jong-Won Ha
- From the Division of Cardiology, Severance Cardiovascular Hospital (I.-C.K., G.-R.H., J.-W.H., C.Y.S.), Department of Cardiovascular Surgery, Severance Cardiovascular Hospital (S.H.L., S.L., B.-C.C.), and Department of Radiology, Research Institute of Radiological Science, Severance Hospital (S.C., Y.J.K.), Yonsei University College of Medicine; and Division of Cardiology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University (I.-C.K.)
| | - Byung-Chul Chang
- From the Division of Cardiology, Severance Cardiovascular Hospital (I.-C.K., G.-R.H., J.-W.H., C.Y.S.), Department of Cardiovascular Surgery, Severance Cardiovascular Hospital (S.H.L., S.L., B.-C.C.), and Department of Radiology, Research Institute of Radiological Science, Severance Hospital (S.C., Y.J.K.), Yonsei University College of Medicine; and Division of Cardiology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University (I.-C.K.)
| | - Young Jin Kim
- From the Division of Cardiology, Severance Cardiovascular Hospital (I.-C.K., G.-R.H., J.-W.H., C.Y.S.), Department of Cardiovascular Surgery, Severance Cardiovascular Hospital (S.H.L., S.L., B.-C.C.), and Department of Radiology, Research Institute of Radiological Science, Severance Hospital (S.C., Y.J.K.), Yonsei University College of Medicine; and Division of Cardiology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University (I.-C.K.)
| | - Chi Young Shim
- From the Division of Cardiology, Severance Cardiovascular Hospital (I.-C.K., G.-R.H., J.-W.H., C.Y.S.), Department of Cardiovascular Surgery, Severance Cardiovascular Hospital (S.H.L., S.L., B.-C.C.), and Department of Radiology, Research Institute of Radiological Science, Severance Hospital (S.C., Y.J.K.), Yonsei University College of Medicine; and Division of Cardiology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University (I.-C.K.)
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Diagnostic Accuracy of Transthoracic Echocardiography for Infective Endocarditis Findings Using Transesophageal Echocardiography as the Reference Standard: A Meta-Analysis. J Am Soc Echocardiogr 2017; 30:639-646.e8. [DOI: 10.1016/j.echo.2017.03.007] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Indexed: 01/23/2023]
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Sekar P, Johnson JR, Thurn JR, Drekonja DM, Morrison VA, Chandrashekhar Y, Adabag S, Kuskowski MA, Filice GA. Comparative Sensitivity of Transthoracic and Transesophageal Echocardiography in Diagnosis of Infective Endocarditis Among Veterans With Staphylococcus aureus Bacteremia. Open Forum Infect Dis 2017; 4:ofx035. [PMID: 28470017 DOI: 10.1093/ofid/ofx035] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 02/20/2017] [Indexed: 12/12/2022] Open
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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Affiliation(s)
- Poorani Sekar
- Veterans Affairs Health Care System, Minneapolis, Minnesota; University of Minnesota, Minneapolis
| | - James R Johnson
- Veterans Affairs Health Care System, Minneapolis, Minnesota; University of Minnesota, Minneapolis
| | - Joseph R Thurn
- Veterans Affairs Health Care System, Minneapolis, Minnesota; University of Minnesota, Minneapolis
| | - Dimitri M Drekonja
- Veterans Affairs Health Care System, Minneapolis, Minnesota; University of Minnesota, Minneapolis
| | - Vicki A Morrison
- Veterans Affairs Health Care System, Minneapolis, Minnesota; University of Minnesota, Minneapolis
| | | | - Selcuk Adabag
- Veterans Affairs Health Care System, Minneapolis, Minnesota; University of Minnesota, Minneapolis
| | - Michael A Kuskowski
- Veterans Affairs Health Care System, Minneapolis, Minnesota; University of Minnesota, Minneapolis
| | - Gregory A Filice
- Veterans Affairs Health Care System, Minneapolis, Minnesota; University of Minnesota, Minneapolis
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Barton T, Moir S, Rehmani H, Woolley I, Korman TM, Stuart RL. Low rates of endocarditis in healthcare-associated Staphylococcus aureus bacteremia suggest that echocardiography might not always be required. Eur J Clin Microbiol Infect Dis 2016; 35:49-55. [PMID: 26490139 DOI: 10.1007/s10096-015-2505-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 10/05/2015] [Indexed: 12/20/2022]
Abstract
Healthcare-associated Staphylococcus aureus bacteremia (HA-SAB) is an increasingly frequently observed complication of medical treatment. Current guidelines recommend evaluation with echocardiography and preferably transesophageal echocardiography for the exclusion of infectious endocarditis (IE). We performed a retrospective analysis of all patients with HA-SAB between 1 January 2007 and 31 July 2012. Patients were divided into those with a high degree of clinical suspicion of IE (prosthetic intracardiac device, hemodialysis or positive blood cultures for 4 days or more) or those with a low degree of clinical suspicion of IE (absence of high-risk features based on previous literature as strong indicators of endocarditis). Three hundred and fifty-eight patients with HA-SAB were evaluated to determine the prevalence of IE, including 298 (83 %) who had echocardiography. Fourteen patients (4 %) had a final diagnosis of IE after echocardiography. In the group with a high degree of clinical suspicion 11 out of 84 patients (13 %) had IE. In the group with a low degree of clinical suspicion group 3 out 274 patients (1.1 %) had IE. HA-SAB has a low rate of IE, especially in the absence of high-risk features such as prolonged bacteremia, intracardiac prosthetic devices, and hemodialysis. Echocardiographic imaging in this low-risk population of patients is rarely helpful and may generally be avoided, although careful clinical follow-up is warranted. Patients with HA-SAB who have mechanical valves, intracardiac devices, prolonged bacteremia or dialysis dependency have a high incidence of IE and should be evaluated thoroughly using echocardiography.
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16
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Galyfos G, Giannakakis S, Kerasidis S, Geropapas G, Kastrisios G, Papacharalampous G, Maltezos C. Infective endocarditis as a rare cause for acute limb ischemia. World J Emerg Med 2016; 7:231-3. [PMID: 27547285 DOI: 10.5847/wjem.j.1920-8642.2016.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- George Galyfos
- Department of Vascular Surgery, KAT General Hospital, Athens 14122, Greece
| | | | - Stavros Kerasidis
- Department of Vascular Surgery, KAT General Hospital, Athens 14122, Greece
| | - Georgios Geropapas
- Department of Vascular Surgery, KAT General Hospital, Athens 14122, Greece
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17
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Cunha BA. Microbiologic and echocardiographic pitfalls in diagnosis of native valve Staphylococcus aureus acute bacterial endocarditis (ABE): a clinical approach. J Chemother 2016; 28:441-2. [PMID: 26082129 DOI: 10.1179/1973947815y.0000000051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Burke A Cunha
- a Infectious Disease Division , Winthrop-University Hospital , Mineola , NY , USA.,b State University of New York , School of Medicine , Stony Brook , NY , USA
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18
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Sivak JA, Vora AN, Navar AM, Schulte PJ, Crowley AL, Kisslo J, Corey GR, Liao L, Wang A, Velazquez EJ, Samad Z. An Approach to Improve the Negative Predictive Value and Clinical Utility of Transthoracic Echocardiography in Suspected Native Valve Infective Endocarditis. J Am Soc Echocardiogr 2016; 29:315-22. [PMID: 26850679 PMCID: PMC6052444 DOI: 10.1016/j.echo.2015.12.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND In patients with suspected native valve infective endocarditis, current guidelines recommend initial transthoracic echocardiography (TTE) followed by transesophageal echocardiography (TEE) if clinical suspicion remains. The guidelines do not account for the quality of initial TTE or other findings that may alter the study's diagnostic characteristics. This may lead to unnecessary TEE when initial TTE was sufficient to rule out vegetation. METHODS The objective of this study was to determine if the use of a strict definition of negative results on TTE would improve the performance characteristics of TTE sufficiently to exclude vegetation. A retrospective analysis of patients at a single institution with suspected native valve endocarditis who underwent TTE followed by TEE within 7 days between January 1, 2007, and February 28, 2014, was performed. Negative results on TTE for vegetation were defined by either the standard approach (no evidence of vegetation seen on TTE) or by applying a set of strict negative criteria incorporating other findings on TTE. Using TEE as the gold standard for the presence of vegetation, the diagnostic performance of the two transthoracic approaches was compared. RESULTS In total, 790 pairs of TTE and TEE were identified. With the standard approach, 661 of the transthoracic studies had negative findings (no vegetation seen), compared with 104 studies with negative findings using the strict negative approach (meeting all strict negative criteria). The sensitivity and negative predictive value of TTE for detecting vegetation were substantially improved using the strict negative approach (sensitivity, 98% [95% CI, 95%-99%] vs 43% [95% CI, 36%-51%]; negative predictive value, 97% [95% CI, 92%-99%] vs 87% [95% CI, 84%-89%]). CONCLUSIONS The ability of TTE to exclude vegetation in patients is excellent when strict criteria for negative results are applied. In patients at low to intermediate risk with strict negative results on TTE, follow-up TEE may be unnecessary.
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Affiliation(s)
- Joseph A Sivak
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Amit N Vora
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Ann Marie Navar
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | | | - Anna Lisa Crowley
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Joseph Kisslo
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - G Ralph Corey
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Lawrence Liao
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Andrew Wang
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Eric J Velazquez
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Zainab Samad
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
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Staphylococcus aureus Endocarditis with Multivalvular Involvement Secondary to an Atrial Septal Defect. Case Rep Cardiol 2016; 2016:3793968. [PMID: 26989519 PMCID: PMC4771888 DOI: 10.1155/2016/3793968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/24/2016] [Indexed: 11/17/2022] Open
Abstract
Infective endocarditis is usually diagnosed using modified Duke's criteria. Our patient had a subacute presentation and a low suspicion for endocarditis during admission, unfortunately leading to her death. Despite advances in diagnostic and therapeutic measures including antibiotic therapy and surgical techniques, morbidity and mortality with staphylococcal infective endocarditis remain high. Hence, we stress the significance of having a low threshold for TEE in patients with multisystem involvement due to Staphylococcus aureus that have evidence of persistent infection despite antibiotic treatment, even if the suspicion for endocarditis is low based on Duke's criteria. TEE substantially improves the sensitivity of diagnosis but may not be readily available in many medical centers. Presence of an ASD has been noted to have increased the risk of left sided endocarditis even with conditions that predispose to right sided endocarditis, particularly in patients with hemodialysis and diabetes as morbid risk factors.
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Baddour LM, Wilson WR, Bayer AS, Fowler VG, Tleyjeh IM, Rybak MJ, Barsic B, Lockhart PB, Gewitz MH, Levison ME, Bolger AF, Steckelberg JM, Baltimore RS, Fink AM, O'Gara P, Taubert KA. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation 2015; 132:1435-86. [PMID: 26373316 DOI: 10.1161/cir.0000000000000296] [Citation(s) in RCA: 1889] [Impact Index Per Article: 209.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Infective endocarditis is a potentially lethal disease that has undergone major changes in both host and pathogen. The epidemiology of infective endocarditis has become more complex with today's myriad healthcare-associated factors that predispose to infection. Moreover, changes in pathogen prevalence, in particular a more common staphylococcal origin, have affected outcomes, which have not improved despite medical and surgical advances. METHODS AND RESULTS This statement updates the 2005 iteration, both of which were developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It includes an evidence-based system for diagnostic and treatment recommendations used by the American College of Cardiology and the American Heart Association for treatment recommendations. CONCLUSIONS Infective endocarditis is a complex disease, and patients with this disease generally require management by a team of physicians and allied health providers with a variety of areas of expertise. The recommendations provided in this document are intended to assist in the management of this uncommon but potentially deadly infection. The clinical variability and complexity in infective endocarditis, however, dictate that these recommendations be used to support and not supplant decisions in individual patient management.
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