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|Title:||Benefit of Echocardiography in Patients With Staphylococcus aureus Bacteremia at Low Risk of Endocarditis.|
|Authors:||Heriot, George S|
Tong, Steven Y C
Cheng, Allen C
|Affiliation:||School of Public Health and Preventative Medicine, Monash University Victoria, Australia.. Victorian Infectious Diseases Service, The Royal Melbourne Hospital, and The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Victoria, Australia..|
Victorian Infectious Diseases Service, The Royal Melbourne Hospital, and The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Victoria, Australia.. Menzies School of Health Research, Royal Darwin Hospital, Northern Territory, Australia..
School of Public Health and Preventative Medicine, Monash University Victoria, Australia.. Department of Infectious Diseases, Alfred Health, Victoria, Australia.. Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Victoria, Australia..
School of Public Health and Preventative Medicine, Monash University Victoria, Australia..
|Citation:||Open forum infectious diseases 2018-12; 5(12): ofy303|
|Abstract:||The risk of endocarditis among patients with Staphylococcus aureus bacteremia is not uniform, and a number of different scores have been developed to identify patients whose risk is less than 5%. The optimal echocardiography strategy for these patients is uncertain. We used decision analysis and Monte Carlo simulation using input parameters taken from the existing literature. The model examined patients with S aureus bacteremia whose risk of endocarditis is less than 5%, generally those with nosocomial or healthcare-acquired bacteremia, no intracardiac prosthetic devices, and a brief duration of bacteremia. We examined 6 echocardiography strategies, including the use of transesophageal echocardiography, transthoracic echocardiography, both modalities, and neither. The outcome of the model was 90-day survival. The optimal echocardiography strategy varied with the risk of endocarditis and the procedural mortality associated with transesophageal echocardiography. No echocardiography strategy offered an absolute benefit in 90-day survival of more than 0.5% compared with the strategy of not performing echocardiography and treating with short-course therapy. Strategies using transesophageal echocardiography were never preferred if the mortality of this procedure was greater than 0.5%. In patients identified to be at low risk of endocarditis, the choice of echocardiography strategy appears to exert a very small influence on 90-day survival. This finding may render test-treatment trials unfeasible and should prompt clinicians to focus on other, more important, management considerations in these patients.|
|Appears in Collections:||NT Health digital library|
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