title: Prioritizing echocardiography in Staphylococcus aureus bacteraemia.
abstract: OBJECTIVE
  Infective endocarditis (IE) is a severe complication in Staphylococcus aureus bacteraemia (SAB) and recent guidelines from the BSAC recommend all patients undergo echocardiography. We assessed the use of echocardiography at a major tertiary referral centre and sought to identify those patients most likely to have positive findings.
  
  
  METHODS
  We retrospectively evaluated all cases of SAB at Oxford University Hospitals NHS Trust between September 2006 and August 2011.
  
  
  RESULTS
  Three-hundred-and-six out of 668 patients with SAB underwent cardiac imaging on average 9.8 ± 1.3 days from the first culture. Thirty-one patients (10.1%) had echocardiographic evidence of IE. Risk factors for observing evidence of IE on scanning included the presence of prosthetic heart valves (32% versus 4%, P < 0.001) or cardiac rhythm management (CRM) devices (16% versus 3%, P < 0.004). On excluding patients with prosthetic valves or CRM devices from the analysis, no patient with a line-related bacteraemia and only one patient (an intravenous drug user) with no/mild regurgitation on transthoracic echocardiography had echo evidence of IE.
  
  
  CONCLUSIONS
  We propose that the use of scarce echocardiography resources could be prioritized. Patients with prosthetic heart valves or a CRM device should receive early cardiological input and transoesophageal echocardiography. In patients with a clearly defined line-related bacteraemia who do not have a prosthetic valve or CRM device or clinical features of IE, response to treatment could be closely monitored and imaging deferred. Patients without a line-related infection or prosthetic valve/device could receive a transthoracic echocardiogram as a screening tool.
authors.affiliation: Oxford Heart Centre, John Radcliffe Hospital,  Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK.
authors.forename: Jubin P
authors.initials: JP
authors.lastname: Joseph
authors.forename: Tom R
authors.initials: TR
authors.lastname: Meddows
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Webster
authors.forename: James D
authors.initials: JD
authors.lastname: Newton
authors.forename: Saul G
authors.initials: SG
authors.lastname: Myerson
authors.forename: Bernard
authors.initials: B
authors.lastname: Prendergast
authors.forename: Matthew
authors.initials: M
authors.lastname: Scarborough
authors.forename: Neil
authors.initials: N
authors.lastname: Herring
mesh_terms: D016470:Bacteremia / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D004696:Endocarditis / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology*; D013211:Staphylococcus aureus / Q000302:isolation & purification / Q000472:pathogenicity; D062606:Tertiary Care Centers; D006113:United Kingdom