A comparative analysis between transthoracic and transesophageal echocardiography in screening for infective endocarditis in patients with Staphylococcus aureus bacteremia

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Background Infective endocarditis is commonly associated with Staphylococcus aureus bacteremia. While various guidelines regarding the need for echocardiography imaging exist, few studies directly compare transthoracic echocardiography (TTE) with transesophageal echocardiography (TEE).Methods We performed a single institution retrospective study from January 1, 2015, through December 31, 2022, that compared the sensitivity of TTE and TEE in patients admitted with a diagnosis of S. aureus bacteremia.Results A total of 196 patients were included in the final analysis. Blood culture results revealed positivity for methicillin-susceptible S. aureus in 62.2% of cases and for methicillin-resistant S. aureus in 34.2% of cases. Thirty-six patients were excluded due to indeterminate imaging findings, leaving a subset of 160 for final analysis. Of this subset, 30 patients were found to have positive imaging findings on TTE and/or TEE. TEE detected 26 cases (87%), while TTE detected 7 cases (23%). TEE was significantly more sensitive than TTE (P = 0.0003).Conclusion In patients with S. aureus bacteremia who underwent sequential TTE followed by TEE, TEE was significantly more sensitive than TTE for detecting imaging evidence of infective endocarditis.

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