Aldred Bruce, Drekonja Dimitri Maximilian
Infectious Diseases Fellow, Department of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Chief, Infectious Disease Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.
Open Forum Infect Dis. 2022 Jun 15;9(7):ofac290. doi: 10.1093/ofid/ofac290. eCollection 2022 Jul.
In patients with bacteremia (SAB), endocarditis evaluation includes transthoracic echocardiography (TTE) and, in patients at increased risk of endocarditis, subsequent transesophageal echocardiography (TEE). Whether performing TTE before TEE influences clinicians' decision making has not been well studied in patients deemed to warrant TEE.
In this retrospective case series, we studied clinician behavior at a large Veterans Affairs medical center regarding the care of adult patients diagnosed with SAB who completed both TTE and TEE ( = 206 episodes of SAB). The timing of key patient management decisions was compared to the timing of the patient's TTE and TEE. It was inferred whether each management decision could have been informed by TTE alone versus TTE plus subsequent TEE. Management decisions included the following: documentation of antibiotic treatment duration, initiation of synergistic antibiotics, consultation of relevant specialists, ordering of relevant imaging studies, and performance of valve surgery or cardiac device explanation.
The primary outcome (any of the above 5 management decisions taking place) occurred after completion of TTE but before TEE in 13 SAB episodes (6.3%). The primary outcome occurred after completion of both TTE and TEE in 178 SAB episodes (86.4%). Documentation of antibiotic treatment duration accounted for the large majority of observed management decisions.
Among patients with SAB who are deemed to warrant TEE for endocarditis evaluation, TTE results alone rarely prompt clinical management decisions.
在患有菌血症（SAB）的患者中，心内膜炎评估包括经胸超声心动图（TTE），对于心内膜炎风险增加的患者，随后进行经食管超声心动图（TEE）。在被认为需要进行TEE的患者中，在进行TEE之前先进行TTE是否会影响临床医生的决策，尚未得到充分研究。
在这个回顾性病例系列中，我们研究了一家大型退伍军人事务医疗中心的临床医生对诊断为SAB并完成了TTE和TEE的成年患者（n = 206例SAB发作）的治疗行为。将关键患者管理决策的时间与患者进行TTE和TEE的时间进行比较。推断每个管理决策是否仅可由TTE或TTE加随后的TEE提供信息。管理决策包括以下内容：抗生素治疗持续时间的记录、协同抗生素治疗 的开始、相关专科医生的会诊、相关影像学检查的开具以及瓣膜手术或心脏装置取出术的实施情况。
主要结局（发生上述5项管理决策中的任何一项）在13例SAB发作中（6.3%）发生在TTE完成后但在TEE之前。主要结局在178例SAB发作中（86.4%）发生在TTE和TEE均完成后。抗生素治疗持续时间的记录占观察到的管理决策的大部分。
在因心内膜炎评估而被认为需要进行TEE的SAB患者中，仅TTE结果很少能促使临床管理决策的做出。
