| Abstrakt: |
Staphylococcus aureus(S aureus) bacteremia has historically been reported to result in endocarditis in 1 of 4 cases. Given the high morbidity and mortality of S aureus, transesophageal echocardiography (TEE) is routinely performed to evaluate for endocarditis. Non-staphyloccal bacteremia does not prompt routine TEE unless high risk clinical features are present. It is unclear how TEE use affects outcomes in patients with S aureusor other bacteremias. We performed a retrospective study of all patients with documented bacteremia at a university medical center from January 1, 2003 to Decmber 31, 2007. Primary outcomes were 30 day and 1 year mortality in patients having TEE vs. no TEE. Analyses for methicillin resistant S aureus(MRSA), methicillin sensitive S aureus(MSSA), and other organisms were performed separately. In the final analysis of 823 patients, we identified 134 cases of MRSA (16.3 of cohort), 148 MSSA (18), 149 Streptococcus sp., 74 Enterococcus sp., and 617 E. colior other. TEE was performed in 87 of 134 (64.9) with MRSA, in 82 of 148 (55.4) with MSSA, and in 320 of 840 (38.1) with other bacteremias (p< 0.0001). Only 11 of 87 (12.6) with MRSA had TEE evidence of endocarditis, compared to 20 of 82 (24.4) with MSSA and 73 of 320 (22.8) with other organisms (p=0.035 for MRSA being less frequent than others). No statistical differences were found for 30 day mortality for any organism regardless of TEE use. At one year, only patients with MRSA undergoing TEE had improved survival; 59 of 87 who had TEE (67.8) were alive, compared to 23 of 47 (48.9) who did not (p=0.0073). Our retrospective analysis challenges previous reports of endocarditis frequency and outcomes in patients with staphyloccal or other bacteremias. TEE utilization was associated with improved 1 year outcomes in patients with MRSA bacteremia, despite endocarditis being less common than previously reported. However, for patients with MSSA bacteremia undergoing TEE, no statistical differences were seen in endocarditis frequency or outcomes compared with all other organisms. These findings suggest the need for a reappraisal of current practice of TEE use in patients with bacteremia. |
