Role of echocardiography in the evaluation of patients with Staphylococcus aureus bacteraemia: time to look at the heart

Abstract

This editorial refers to ‘Prevalence of infective endocarditis in patients with Staphylococcus aureus bacteraemia: the value of screening with echocardiography’ by R.V. Rasmussen et al ., on page 414. In the industrialized countries, the prevalence of Staphylococcus aureus infections is constantly rising, due to the increasing population age and modern invasive medical techniques.1 Staphylococcus aureus bacteraemia is frequently hospital- or health-care-related, encountered in post-operative patients, and almost any organ system can be involved. Owing to systemic dissemination, metastatic abscess, osteomyelitis, septic arthritis, and endocarditis can occur. Staphylococcus aureus is now the leading cause of infective endocarditis especially in Europe and the USA, and associated with high morbidity and mortality despite advances in antibiotic and surgical therapy options. Positive blood cultures and echocardiography are the pivotal cornerstones of diagnosis in infective endocarditis with the modified Duke criteria.2 Clinical manifestations of endocarditis are often unspecific or missing, new murmurs may occur during the course of disease, and immunologic or vascular phenomena may occur as splinter haemorrhages, Janeway lesions, or Roth spots in some patients. Intravenous drug abuse presents another cause of increase in S. aureus infections especially in larger cities and western countries, frequently leading to right-sided endocarditis. In this issue of the European Journal of Echocardiography, a multi-centre study of 244 patients with S. aureus bacteraemia in six Danish hospitals prospectively examined the prevalence of endocarditis with echocardiography screening.3 A key finding was the strikingly high prevalence of 22% of endocarditis even in patients without clinical manifestations pointing to valvular involvement. In view of the high mortality of untreated endocarditis even in the modern era, this finding underscores the importance of performing early and repeat echocardiography in all patients with S. aureus bacteraemia, as has been recommended by the current ESC guidelines.2 However, many patients still do not …