Table 4.
Impact of TTE and/or TEE Results on Management and Risk of Relapse
| Tests | n | Short Courses (<21 Days) | Long Courses (≥21 Days) | Need for Surgery | |||||
|---|---|---|---|---|---|---|---|---|---|
| Shortened Because of Echocardiogram Results | Lengthened Because of Echocardiogram Results | ||||||||
| TTE | TEE | Yes | No | Relapses/at Risk for Relapsea | Yes | No | Relapses/at Risk for Relapse | ||
| + | nd | 8 | 0 | 0 | 0/0 | 8 (100%) | 0 | 0/3 | 0 |
| − | nd | 66 | 23 (35%) | 0 | 2/23 (9%)b | 0 | 43 (65%) | 2/33 (6%) | 0 |
| + | + | 6 | 0 | 0 | 0/0 | 6 (100%) | 0 | 1/5 (20%)c | 4 (67%) |
| − | + | 22 | 0 | 0 | 0/0 | 16 (73%) | 6 (27%) | 0/19 | 4 (18%) |
| − | − | 91 | 38 (42%) | 0 | 5/38 (13%) | 0 | 53 (58%) | 2/51 (4%) | 0 |
| nd | + | 3 | 0 | 0 | 0/0 | 2 (67%) | 1 (33%) | 0/3 | 0 |
| nd | − | 8 | 2 (25%) | 0 | 0/2 | 0 | 6 (75%) | 0/6 | 0 |
| nd | nd | 11 | nd | 10 (91%) | 1/7 (14%) | nd | 1 (9%) | 0/1 | 0 |
| All cases | 215 | 63 | 10 | 8/70 (11%) | 32 | 110 | 5/121 (4%) | 8 (4%) | |
Abbreviations: +, echocardiogram results were positive; −, echocardiogram results were negative; IE, infective endocarditis; nd, not done; SAB, Staphylococcus aureus bacteremia; TEE, transesophageal echocardiography; TTE, transthoracic echocardiography.
NOTE: No cases had positive TEE and negative TEE.
aDefinitions: At risk for relapse = patient lived until after therapy was completed; relapse = new clinical episode of deep or systemic S aureus infection within 1 year of SAB diagnosis, provided the new S aureus isolate had the same oxacillin susceptibility as the initial isolate. Cases were excluded from analysis for relapses if focal infections present during the initial SAB were not adequately drained or if infected prostheses were not removed and infection recurred at the same site.
bIn the 2 cases with relapse, IE was not diagnosed initially, and duration of therapy was 2 weeks. SAB recurred within 4 months, and IE was indicated by the presence of vegetations.
cIn the case with relapse, IE was diagnosed contemporaneously with initial SAB, and duration of therapy was 6 weeks. Ten weeks later, SAB recurred with IE and discitis.