title: Prevalence of infective endocarditis in patients with Staphylococcus aureus bacteraemia: the value of screening with echocardiography.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, Copenhagen University Hospital, Gentofte, Niels Andersens vej 65, post 4210, 2900 Hellerup, Denmark. vedby@webspeed.dk
authors.forename: Rasmus V
authors.initials: RV
authors.lastname: Rasmussen
authors.forename: Ulla
authors.initials: U
authors.lastname: Høst
authors.forename: Magnus
authors.initials: M
authors.lastname: Arpi
authors.forename: Christian
authors.initials: C
authors.lastname: Hassager
authors.forename: Helle K
authors.initials: HK
authors.lastname: Johansen
authors.forename: Eva
authors.initials: E
authors.lastname: Korup
authors.forename: Henrik C
authors.initials: HC
authors.lastname: Schønheyder
authors.forename: Jens
authors.initials: J
authors.lastname: Berning
authors.forename: Sabine
authors.initials: S
authors.lastname: Gill
authors.forename: Flemming S
authors.initials: FS
authors.lastname: Rosenvinge
authors.forename: Vance G
authors.initials: VG
authors.lastname: Fowler
authors.forename: Jacob E
authors.initials: JE
authors.lastname: Møller
authors.forename: Robert L
authors.initials: RL
authors.lastname: Skov
authors.forename: Carsten T
authors.initials: CT
authors.lastname: Larsen
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Hansen
authors.forename: Shan
authors.initials: S
authors.lastname: Mard
authors.forename: Jesper
authors.initials: J
authors.lastname: Smit
authors.forename: Paal S
authors.initials: PS
authors.lastname: Andersen
authors.forename: Niels E
authors.initials: NE
authors.lastname: Bruun
mesh_terms: D016009:Chi-Square Distribution; D016001:Confidence Intervals; D003718:Denmark / Q000453:epidemiology; D004452:Echocardiography / Q000295:instrumentation*; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D016015:Logistic Models; D008403:Mass Screening; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D013223:Statistics as Topic; D018709:Statistics, Nonparametric