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Clinical, Serologic, and Echocardiographic Findings in Patients With and Without Endocarditis

Arnold S. Bayer, MD; Kitty Lam, MD; Leonard Ginzton, MD; Dean C. Norman, MD; Chung-Yin Chiu, MS; Joel I. Ward, MD

Arch Intern Med. 1987;147(3):457-462.

Abstract
• Seventy-two adult patients with Staphylococcus aureus bacteremia were prospectively studied clinically, serologically, and echocardiographically. Multivariate analysis identified four parameters that significantly predicted endocarditis in staphylococcemic patients at time of initial evaluation: (1) absence of a primary site of infection; (2) community acquisition of infection; (3) metastatic sequelae; and (4) valvular vegetations detected by echocardiography. Echocardiography was most predictive of endocarditis in patients with community-acquired S aureus bacteremia from an obvious primary focus. In 11 (69%) of 16 patients with endocarditis and vegetations on two-dimensional echocardiography, this technique also revealed other important findings, including ventricular dilatation, and/or underlying valvular lesions. In 18% of patients with S aureus bacteremia without stigmata of endocarditis, echocardiography provided information that led to a diagnosis of endocarditis and a subsequent change in therapy. Our findings support the routine use of two-dimensional echocardiography in all cases of community-acquired S aureus bacteremia to identify occult endocarditis in patients without classic stigmata of disease, and to provide important prognostic data in clinically apparent endocarditis.

(Arch Intern Med 1987;147:457-462)

Author Affiliations
From the Departments of Medicine (Drs Bayer, Lam, Ginzton, and Norman) and Pediatrics (Dr Ward and Mr Chiu), Harbor-UCLA Medical Center, Torrance, Calif, and the UCLA School of Medicine (Drs Bayer, Lam, Ginzton, Norman, and Ward).

Footnotes
Accepted for publication April 26, 1986.

Reprint requests to Division of Adult Infectious Diseases, Harbor/UCLA Medical Center, 1000 W Carson St, Bldg E-5, Torrance, CA 90509 (Dr Bayer).

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