title: Perivalvular abscesses due to Staphylococcus aureus endocarditis comparison with Streptococcus viridans endocarditis and incremental value of transesophageal echocardiography.
abstract: BACKGROUND
  Perivalvular abscesses are major complications of infective endocarditis (IE). The prevalence and best approach to detection of this complication in Staphylococcus aureus (SA) in comparison to Streptococcus viridans (SV) IE is unclear.
  
  
  METHODS
  Among 243 consecutive episodes of IE diagnosed using the Duke criteria, who underwent either transthoracic (TTE) or transesophageal echocardiography (TEE) at the Mayo Clinic between 1988 and 1993, there were 64 cases of SV and 61 of SA IE. Comparison of TTE and TEE detection of abscesses were restricted to patients with either surgical or autopsy examination and both TTE and TEE were performed.
  
  
  RESULTS
  Prosthetic valve and valve repair were significantly higher in SA compared to SV IE (46 vs 23%, P = 0.008). The prevalence of abscesses was higher in SA compared to SV IE (42 vs 14%, P = 0.08). 1 (10%) of abscess detected by TTE in SA compared to 1 (50%) in SV IE and 6 (60%) by TEE in SA and 1 (50%) in SV IE. Incremental value of TEE vs TTE was higher in SA 5/24 (21%) than in SV IE 0/14 (0%) P = 0.067. Hospital mortality was significantly higher in SA than SV IE (13 vs 2%, P = 0.013).
  
  
  CONCLUSIONS
  Patients diagnosed with IE and those with SA 1) presented more often with prosthetic valve IE, 2) developed more perivalvular abscesses, and 3) had a higher in hospital mortality than those with SV. Incremental value of TEE was higher in SA than in SV IE, 4) therefore, had a stringent requirement for initial and repeated TEE to detect this ominous complication of IE.
authors.affiliation: Division of Cardiovascular Disease and Internal Medicine, Srinagarind Hospital, Khon Kaen University, Thailand.
authors.forename: O
authors.initials: O
authors.lastname: Pachirat
authors.forename: V
authors.initials: V
authors.lastname: Klungboonkrong
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging / Q000453:epidemiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012042:Registries; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013290:Streptococcal Infections / Q000000981:diagnostic imaging / Q000453:epidemiology*; D013291:Streptococcus / Q000302:isolation & purification; D015996:Survival Rate