Issue: 2011 > July/August > original article

Endocarditis: effects of routine echocardiography during Gram-positive bacteraemia

F.J. Vos, C.P. Bleeker-Rovers, P.D. Sturm, P.F.M. Krabbe, A.P.J. van Dijk, W.J.G. Oyen, B.J. Kullberg


Background: Despite firm recommendations to perform
echocardiography in high-risk patients with Gram-positive bacteraemia, routine echocardiography is not embedded in daily practice in many settings. The aim of this study was to evaluate whether a regime including routine echocardiography results in better outcome.
Methods: A total of 115 patients with Gram-positive
bacteraemia and at least one risk factor for developing
metastatic infection were prospectively included. Routine
echocardiography was advocated and facilitated in these
patients. Results were compared with a matched historical control group of 230 patients in whom echocardiography was performed at the discretion of the attending physician. Endocarditis was diagnosed according to the Duke criteria. Results: Echocardiography was performed more often in the study group (82 vs 27%, p<0.001). Endocarditis was
diagnosed more often among study patients, 22/115 (19%) vs 17/230 (7%) in the control group (p=0.002). In the study group echocardiography revealed vegetations in 22 of 94 (23%) patients, compared with 17 of 64 (27%) control patients (p=0.7). In the absence of heart murmurs, 70% of patients underwent echocardiography in the study group against 21% in the control group (p<0.001). No differences in adherence to American Heart Association guidelines concerning treatment of endocarditis were noticed. In patients with endocarditis, overall mortality was 23% in study patients and 59% in controls (p=0.04). Conclusion: Routinely performed echocardiography in patients with Gram-positive bacteraemia resulted in diagnosing endocarditis in a larger proportion of patients, which was associated with a significant decrease in mortality rates. In the past, endocarditis was probably detected in a more advanced stage.