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New criteria for nosocomial S. aureus may identify patients at low risk for infective endocarditis
Kaasch AJ. Clin Infect Dis. 2011;53:1-9.
A new set of criteria for nosocomial Staphylococcus aureus bacteremia may identify patients at low risk for infective endocarditis, and those who meet these criteria may not routinely require transesophageal echocardiography, according to Achim J. Kaasch, MD, and colleagues.
“Contrary to current recommendations, transesophageal echocardiography to rule out endocarditis is not necessary in all patients with nosocomial S. aureus bacteremia,” Kaasch, of the Institute for Medical Microbiology, Immunology and Hygiene in Cologne, Germany, told Infectious Disease News. “With the help of a simple criteria set, physicians will be able to decide which patients with nosocomial S. aureus bacteremia do not need echocardiographic evaluation. This may help to reduce the number of echocardiographic evaluations performed without compromising patient safety.”
The researchers developed and validated criteria to identify patients at low risk for infective endocarditis who may not need transesophageal echocardiography. The current cohort included patients from the Invasive S. aureus Infection Cohort (INSTINCT) in Europe (n=304) and the S. aureus Bacteremia Group (SABG) in North America (n=432).
Clinical signs and symptoms of infective endocarditis were observed in patients during hospitalization and 3-month follow-up. Compared with 9.3% of patients included in the SABG trial, 4.3% of patients from the INSTINCT trial had infective endocarditis. Echocardiography was performed in 57.4% of those in the SABG trial and in 39.8% of those in the INSTINCT trial.
Prolonged bacteremia were the most common clinical prediction criteria in those with infective endocarditis, with 69.2% and 90% present in those included in the INSTINCT and SABG trials, respectively. This was followed by the presence of a permanent intracardiac device (53.8% and 32.5%, respectively).
Moreover, methicillin-resistant S. aureus was more common in the US cohort vs. the European cohort in those with (80% vs. 7.7%) and without infective endocarditis (64.3% vs. 15.8%).
“In total, 13 of 13 patients in the INSTINCT cohort and 39 of 40 in the SABG cohort with documented infective endocarditis fulfilled at least one criterion,” the researchers wrote. “Furthermore, clinicians should be encouraged by ID physicians and clinical microbiologists to perform follow-up cultures for all patients with [S. aureus bacteremia] 2 to 4 days after the first positive blood culture result. Nevertheless, it is of critical importance to confirm the validity of the proposed prediction criteria prospectively in a controlled study, in which all patients with [S. aureus bacteremia] would undergo echocardiography and follow-up blood cultures.”
Disclosure: Dr. Kaasch reports no relevant financial disclosures.
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