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

TY - JOUR

T1 - Prevalence of infective endocarditis in patients with Staphylococcus aureus bacteraemia

T2 - the value of screening with echocardiography

AU - Rasmussen, Rasmus V

AU - Høst, Ulla

AU - Arpi, Magnus

AU - Hassager, Christian

AU - Johansen, Helle K

AU - Korup, Eva

AU - Schønheyder, Henrik C

AU - Berning, Jens

AU - Gill, Sabine

AU - Rosenvinge, Flemming S

AU - Fowler, Vance G

AU - Møller, Jacob E

AU - Skov, Robert L

AU - Larsen, Carsten T

AU - Hansen, Thomas F

AU - Mard, Shan

AU - Smit, Jesper

AU - Andersen, Paal S

AU - Bruun, Niels E

PY - 2011/6/1

Y1 - 2011/6/1

N2 - 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. Corresponding author.

AB - 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. Corresponding author.

U2 - 10.1093/ejechocard/jer023

DO - 10.1093/ejechocard/jer023

M3 - Journal article

SN - 1525-2167

VL - 12

SP - 414

EP - 420

JO - European Journal of Echocardiography

JF - European Journal of Echocardiography

IS - 6

ER -