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Forgoing transesophageal echocardiogram in selected patients with complicated Staphylococcus aureus bacteremia

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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.

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Code availability

The data that support the findings of this study are available on request from the corresponding author.

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Authors and Affiliations

  1. Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada

    John C. Lam

  2. Departments of Medicine and Pathology & Laboratory Medicine, Calgary Laboratory Services, and the Snyder Institute for Chronic Disease, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada

    Daniel B. Gregson

  3. Departments of Medicine and Microbiology, Immunology & Infectious Diseases, Snyder Institute for Chronic Disease, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada

    Ranjani Somayaji & Michael D. Parkins

  4. Department of Medicine, Dalhousie University, 5849 University Ave, Halifax, NS, B3H 4R2, Canada

    Stephen Robinson

  5. Departments of Medicine and Microbiology, Immunology & Infectious Diseases, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada

    John M. Conly

  6. Department of Cardiac Sciences, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada

    Lisa Welikovitch

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  1. John C. Lam
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  7. Michael D. Parkins
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Contributions

Conceptualization: SR, DBG, MDP; investigation: JCL, DBG, SR, MDP; formal analysis: JCL, MDP; data curation: JCL, DBG, SR, MDP; writing—original draft: JCL; writing—review and editing: JCL, DBG, SR, RS, LW, JMC, MDP.

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Correspondence to Michael D. Parkins.

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The authors declare that they have no conflicts of interest.

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This study was approved by the Conjoint Health Research Ethics Board at the University of Calgary (REB14_1456).

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Lam, J.C., Gregson, D.B., Somayaji, R. et al. Forgoing transesophageal echocardiogram in selected patients with complicated Staphylococcus aureus bacteremia. Eur J Clin Microbiol Infect Dis 40, 623–631 (2021). https://doi.org/10.1007/s10096-020-04097-y

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  • DOI: https://doi.org/10.1007/s10096-020-04097-y

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