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Prevalence of infective endocarditis in patients with Staphylococcus aureus bacteraemia: the value of screening with echocardiography.

Rasmussen, Rasmus V; Høst, Ulla; Arpi, Magnus; Hassager, Christian; Johansen, Helle K; Korup, Eva; Schønheyder, Henrik C; Berning, Jens; Gill, Sabine; Rosenvinge, Flemming S; Fowler, Vance G; Møller, Jacob E; Skov, Robert L; Larsen, Carsten T; Hansen, Thomas F; Mard, Shan; Smit, Jesper; Andersen, Paal S; Bruun, Niels E.
Eur J Echocardiogr; 12(6): 414-20, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21685200

AIMS:

Staphylococcus aureus infective endocarditis (IE) is a critical medical condition associated with a high morbidity and mortality. In the present study, we prospectively evaluated the importance of screening with echocardiography in an unselected S. aureus bacteraemia (SAB) population.

METHODS AND RESULTS:

From 1 January 2009 to 31 August 2010, a total of 244 patients with SAB at six Danish hospitals underwent screening echocardiography. The inclusion rate was 73% of all eligible patients (n= 336), and 53 of the 244 included patients (22%; 95% CI: 17-27%) were diagnosed with definite IE. In patients with native heart valves the prevalence was 19% (95% CI: 14-25%) compared with 38% (95% CI: 20-55%) in patients with prosthetic heart valves and/or cardiac rhythm management devices (P= 0.02). No difference was found between Main Regional Hospitals and Tertiary Cardiac Hospitals, 20 vs. 23%, respectively (NS). The prevalence of IE in high-risk patients with one or more predisposing condition or clinical evidence of IE were significantly higher compared with low-risk patients with no additional risk factors (38 vs. 5%; P < 0.001). IE was associated with a higher 6 months mortality, 14(26%) vs. 28(15%) in SAB patients without IE, respectively (P < 0.05).

CONCLUSION:

SAB patients carry a high risk for development of IE, which is associated with a worse prognosis compared with uncomplicated SAB. The presenting symptoms and clinical findings associated with IE are often non-specific and echocardiography should always be considered as part of the initial evaluation of SAB patients.
Selo DaSilva