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Title: | Low rates of endocarditis in healthcare-associated Staphylococcus aureus bacteremia suggest that echocardiography might not always be required. | Authors: | Barton T.;Rehmani H.;Moir S.;Woolley I. ;Korman T. ;Stuart R.L. | Monash Health Department(s): | Infectious Diseases and Clinical Microbiology | Institution: | (Barton, Moir, Rehmani) MonashHEART, Monash Health, 246 Clayton Road, Clayton 3168, Australia (Barton, Moir, Rehmani, Woolley, Korman, Stuart) Department Medicine, Monash University, Clayton, Vic 3168, Australia (Woolley, Korman, Stuart) Monash Infectious Diseases, Monash Health, 246 Clayton Road, Clayton, Vic 3168, Australia | Issue Date: | 25-Jan-2016 | Copyright year: | 2016 | Publisher: | Springer Verlag (E-mail: service@springer.de) | Place of publication: | Germany | Publication information: | European Journal of Clinical Microbiology and Infectious Diseases. 35 (1) (pp 49-55), 2016. Date of Publication: 01 Jan 2016. | Journal: | European Journal of Clinical Microbiology and Infectious Diseases | 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.Copyright © 2015, Springer-Verlag Berlin Heidelberg. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1007/s10096-015-2505-8 | PubMed URL: | 26490139 [http://www.ncbi.nlm.nih.gov/pubmed/?term=26490139] | ISSN: | 0934-9723 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/39607 | Type: | Article | Subjects: | human incidence low risk patient major clinical study male mitral valve regurgitation mortality rate prevalence priority journal prosthetic valve endocarditis real time ultrasound scanner retrospective study *staphylococcal bacteremia transesophageal echocardiography transthoracic echocardiography catheter related Staphylococcus aureus bacteremia *healthcare associated Staphylococcus aureus bacteremia penicillin sensitive Staphylococcus aureus bacteremia methicillin resistant Staphylococcus aureus infection adult antibiotic therapy article artificial heart *bacterial endocarditis blood culture catheter infection clinical feature controlled study disease duration disease severity echocardiograph *echocardiography female follow up *healthcare associated infection hemodialysis high risk patient *echocardiography female follow up *healthcare associated infection hemodialysis high risk patient human incidence low risk patient major clinical study male methicillin resistant Staphylococcus aureus infection mitral valve regurgitation mortality rate prevalence priority journal prosthetic valve endocarditis real time ultrasound scanner retrospective study artificial heart transesophageal echocardiography transthoracic echocardiography Article antibiotic therapy adult *staphylococcal bacteremia *bacterial endocarditis blood culture catheter infection clinical feature controlled study disease duration disease severity echocardiograph |
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