Heriot G, Yeoh J, Street A, Ratnam I
Victorian Infectious Diseases Service, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, 3050, Australia,
Eur J Clin Microbiol Infect Dis. 2015 Jun;34(6):1231-6. doi: 10.1007/s10096-015-2352-7. Epub 2015 Feb 26.
Current guidelines recommend performing echocardiography in all patients with Staphylococcus aureus bacteremia (SAB), but patients at very low risk of endocarditis may not benefit from this investigation. This study seeks to identify patients at very low risk of endocarditis. A retrospective single-center consecutive case series of patients with SAB was examined. Microbiological and echocardiographic data were used to identify patients with community onset, prolonged bacteremia, and intracardiac prosthetic devices. The diagnostic performance of these criteria for endocarditis as measured against transesophageal echocardiography (TEE) was calculated. 593 episodes of SAB were examined over a period of 6 years. 10 % were excluded from analysis due to death or discharge less than 48 h after the first positive blood culture or no admission to hospital, leaving 532 episodes for analysis. 64 % of the included episodes were investigated with echocardiography: 39 % with TEE and 26 % with transthoracic echocardiography (TTE) only. 16 % of the episodes investigated with echocardiography were demonstrated to have endocarditis. The rate of endocarditis was higher for episodes undergoing TEE (24 %) than TTE only (5 %). There were no instances of endocarditis amongst the 23 episodes investigated with TEE where none of the three risk factors were present. This group represented 57 % of the nosocomial (non-community-onset) episodes investigated with TEE. Patients with none of the three criteria examined in this study have a very low rate of endocarditis and may fall below the test threshold for echocardiography.
当前指南建议对所有金黄色葡萄球菌菌血症（SAB）患者进行超声心动图检查，但感染性心内膜炎风险极低的患者可能无法从这项检查中获益。本研究旨在识别感染性心内膜炎风险极低的患者。我们对一个单中心的SAB患者回顾性连续病例系列进行了检查。利用微生物学和超声心动图数据来识别社区发病、菌血症持续时间延长以及心腔内有假体装置的患者。计算了这些心内膜炎诊断标准相对于经食管超声心动图（TEE）的诊断性能。在6年时间里共检查了593例SAB发作病例。10%的病例因首次血培养阳性后48小时内死亡或出院，或未入院而被排除在分析之外，剩余532例发作病例用于分析。纳入分析的病例中有64%接受了超声心动图检查：39%接受了TEE检查，26%仅接受了经胸超声心动图（TTE）检查。接受超声心动图检查的病例中有16%被证实患有感染性心内膜炎。接受TEE检查的病例的感染性心内膜炎发生率（24%）高于仅接受TTE检查的病例（5%）。在接受TEE检查且不存在三个风险因素中的任何一个的23例病例中，没有出现感染性心内膜炎的情况。这组病例占接受TEE检查的医院获得性（非社区发病）病例的57%。本研究中未具备这三个标准中任何一个的患者感染性心内膜炎发生率极低，可能低于超声心动图检查的阈值。
