Skip to main content
Journal cover image

Role of echocardiography in evaluation of patients with Staphylococcus aureus bacteremia: experience in 103 patients.

Publication ,  Journal Article
Fowler, VG; Li, J; Corey, GR; Boley, J; Marr, KA; Gopal, AK; Kong, LK; Gottlieb, G; Donovan, CL; Sexton, DJ; Ryan, T
Published in: J Am Coll Cardiol
October 1997

OBJECTIVES: The purpose of this prospective study was to examine the role of echocardiography in patients with Staphylococcus aureus bacteremia (SAB). BACKGROUND: The reported incidence of infective endocarditis (IE) among patients with SAB varies widely. Distinguishing patients with uncomplicated bacteremia from those with IE is therapeutically and prognostically important, but often difficult. METHODS: One hundred-three consecutive patients undergoing both transthoracic (TTE) echocardiography and transesophageal (TEE) echocardiography were prospectively evaluated. All patients presented with fever and > or = 1 positive blood culture and were followed up for 12 weeks. RESULTS: Although predisposing heart disease was present in 42 patients (41%), clinical evidence of infective endocarditis (IE) was rare (7%). TTE revealed anatomic abnormalities in 33 patients, but vegetations in only 7 (7%), and was considered indeterminate in 19 (18%). TEE identified vegetations in 22 patients (aortic valve in 5, mitral valve in 9, tricuspid valve in 4, catheter in 2 and pacemaker in 2, abscesses in 2, valve perforation in 1 and new severe regurgitation in 1; 26 total [25%]). Using Duke criteria for the diagnosis of IE, definite IE was present in 26 patients (25%). Clinical findings and predisposing heart disease did not distinguish between patients with and without IE. The sensitivity of TTE for detecting IE was 32%, and the specificity was 100%. The addition of TEE increased the sensitivity to 100%, but resulted in one false positive result (specificity 99%). TEE detected evidence of IE in 19% of patients with a negative TTE and 21% of patients with an indeterminate TTE. At follow-up, cure of staphylococcal infection occurred in a similar percentage of patients with and without IE (77% and 75%, respectively). However, death due to sepsis was significantly more likely among patients with IE (4 of 26 [15%]) than among those without IE (2 of 77 [3%]) (p = 0.03). CONCLUSIONS: Our results suggest that IE is common among patients admitted to the hospital with SAB and is associated with an increased risk of death due to sepsis. TEE is essential to establish the diagnosis and to detect associated complications. Therefore, the test should be considered part of the early evaluation of patients with SAB.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

October 1997

Volume

30

Issue

4

Start / End Page

1072 / 1078

Location

United States

Related Subject Headings

  • Staphylococcus aureus
  • Staphylococcal Infections
  • Sensitivity and Specificity
  • Reproducibility of Results
  • Prospective Studies
  • Prognosis
  • Middle Aged
  • Male
  • Incidence
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Fowler, V. G., Li, J., Corey, G. R., Boley, J., Marr, K. A., Gopal, A. K., … Ryan, T. (1997). Role of echocardiography in evaluation of patients with Staphylococcus aureus bacteremia: experience in 103 patients. J Am Coll Cardiol, 30(4), 1072–1078. https://doi.org/10.1016/s0735-1097(97)00250-7
Fowler, V. G., J. Li, G. R. Corey, J. Boley, K. A. Marr, A. K. Gopal, L. K. Kong, et al. “Role of echocardiography in evaluation of patients with Staphylococcus aureus bacteremia: experience in 103 patients.J Am Coll Cardiol 30, no. 4 (October 1997): 1072–78. https://doi.org/10.1016/s0735-1097(97)00250-7.
Fowler VG, Li J, Corey GR, Boley J, Marr KA, Gopal AK, et al. Role of echocardiography in evaluation of patients with Staphylococcus aureus bacteremia: experience in 103 patients. J Am Coll Cardiol. 1997 Oct;30(4):1072–8.
Fowler, V. G., et al. “Role of echocardiography in evaluation of patients with Staphylococcus aureus bacteremia: experience in 103 patients.J Am Coll Cardiol, vol. 30, no. 4, Oct. 1997, pp. 1072–78. Pubmed, doi:10.1016/s0735-1097(97)00250-7.
Fowler VG, Li J, Corey GR, Boley J, Marr KA, Gopal AK, Kong LK, Gottlieb G, Donovan CL, Sexton DJ, Ryan T. Role of echocardiography in evaluation of patients with Staphylococcus aureus bacteremia: experience in 103 patients. J Am Coll Cardiol. 1997 Oct;30(4):1072–1078.
Journal cover image

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

October 1997

Volume

30

Issue

4

Start / End Page

1072 / 1078

Location

United States

Related Subject Headings

  • Staphylococcus aureus
  • Staphylococcal Infections
  • Sensitivity and Specificity
  • Reproducibility of Results
  • Prospective Studies
  • Prognosis
  • Middle Aged
  • Male
  • Incidence
  • Humans