Livesay James, Coombes Tyler, Spoons Jared, Dolacky Steven, Shorman Mahmoud
Department of Cardiovascular Medicine Fellowship, University of Tennessee Graduate School of Medicine, Knoxville, USA.
Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, USA.
Cureus. 2021 Nov 8;13(11):e19372. doi: 10.7759/cureus.19372. eCollection 2021 Nov.
Methicillin-resistant (MRSA) infective endocarditis (IE) is associated with high morbidity and mortality. Current IE guidelines recommend transesophageal echocardiogram (TEE) over transthoracic echocardiogram (TTE) to diagnose infective endocarditis. Management of IE in people who inject drugs (PWID) in many medical centers is mainly conservative with prolonged intravenous antibiotics. Cardiac valve replacement in these patients remains controversial, given the high risk of reinfection. This study's purpose is to evaluate whether obtaining sequential TEE after TTE in PWID with MRSA native-valve IE changes the management plan in these patients.
A retrospective cohort of patients who are 18 years of age or older and inject drugs with definite MRSA IE between 2013 and 2019 were studied. Their echocardiographic reports and overall management plans were reviewed.
One hundred and twenty-six patients met the inclusion criteria. TTE was performed in 121 patients and, of these patients, 69 (57%) had detectable valvular vegetations while 52 (43%) did not. Of the 52 patients with a negative TTE, 44 underwent TEE, 28 (53%) of which showed vegetation. A total of 18 (14%) patients underwent surgery. Of these, six (33%) patients had a positive TTE only, with no subsequent TEE. Ten (56%) patients had both a positive TTE and TEE, and two (11%) patients had a negative TTE but positive TEE.
In this retrospective cohort, obtaining a sequential TEE after a TTE in PWID with proven MRSA native IE by modified Duke's criteria changed the management plan in two patients. The decision to perform a TEE in these patients needs to be individualized. Larger studies are needed to better evaluate the role of TEE in this patient population.
耐甲氧西林金黄色葡萄球菌（MRSA）感染性心内膜炎（IE）与高发病率和死亡率相关。当前的IE指南推荐经食管超声心动图（TEE）而非经胸超声心动图（TTE）来诊断感染性心内膜炎。在许多医疗中心，对注射毒品者（PWID）的IE管理主要是采用延长静脉抗生素治疗的保守方法。鉴于再感染风险高，这些患者的心脏瓣膜置换仍存在争议。本研究的目的是评估在患有MRSA自体瓣膜IE的PWID中，在TTE后进行序贯TEE是否会改变这些患者的管理计划。
对2013年至2019年间年龄在18岁及以上且注射毒品并确诊为MRSA IE的患者进行回顾性队列研究。回顾了他们的超声心动图报告和总体管理计划。
126例患者符合纳入标准。121例患者进行了TTE，其中69例（57%）可检测到瓣膜赘生物，52例（43%）未检测到。在TTE结果为阴性的52例患者中，44例接受了TEE，其中28例（53%）显示有赘生物。共有18例（14%）患者接受了手术。其中，6例（33%）患者仅TTE结果为阳性，未进行后续TEE。10例（56%）患者TTE和TEE结果均为阳性，2例（11%）患者TTE结果为阴性但TEE结果为阳性。
在这个回顾性队列中，在符合改良杜克标准的患有MRSA自体IE的PWID中，TTE后进行序贯TEE改变了两名患者的管理计划。对这些患者进行TEE的决定需要个体化。需要更大规模的研究来更好地评估TEE在这一患者群体中的作用。
