Attention: This is an archive version of the HELP CDSS for documentation purposes. It is neither updated nor actively maintained!
Result of the blood culture
I. S. aureus or S. lugdunensis
I.2. Apparative Diagnostics
I.2.1. Echocardiography
Clear contraindications against a transesophageal echocardiography (TEE)?
If "Yes"
order TTE

If "No"
order TEE
Is there persistent suspicion of endocarditis or are the blood cultures still positive despite adequate therapy?
Repetition of echocardiography after 7 days
CAVE:
Approx. 10% of patients with a S. aureus bacteremia (SAB) have an endocarditis . The diagnosis influences the therapy and prognosis!
Explanatory Notes:
Who gets a TEE?
The indication is risk-adapted . Always indicated in patients with the following:
  • community-acquired bacteremia,
  • cardiac risk factors present (cardiac foreign bodies, heart defect, history of heart transplantation, history of endocarditis),
  • septic metastatic emboli, vertebral osteomyelitis/osteomyelitis, hemodialysis, i.v. drug abuse.
TEE or TTE ?
The transesophageal echocardiography (TEE) has almost twice the diagnostic sensitivity of transthoracic echocardiography (TTE) and should always be used preferentially .
When?
Within a few days (ideally 3-5d) after diagnosis, possibly repetition after 7 days.
Relative and absolute contraindications TEE?
  • postoperative stomach/esophagus, especially within the last 6 weeks,
  • esophageal fistula, abscess or tumor,
  • esophageal varices,
  • malformation of the upper gastrointestinal tract,
  • manifest bleeding of the upper gastrointestinal tract,
  • severe coagulation disorder