FREQUENCY OF BACTEREMIA ASSOCIATED WITH TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN INTENSIVE-CARE UNIT PATIENTS - A PROSPECTIVE-STUDY OF 139 PATIENTS

Objective: To determine the occurrence rate of bacteremia associated w ith transesophageal echocardiography in intensive care unit (ICU) pati ents, Design: A prospective study of 139 patients undergoing transesop hageal echocardiography, Settings: The medical ICU of a tertiary refer ral teaching hospital, Patients: One hundred thirty-nine ICU patients (mean age 58 yrs) who underwent transesophageal echocardiography, Inte rventions: Blood samples were systematically drawn for aerobic and ana erobic culture at the following times: before (blood culture 1), at th e end of (blood culture 2), and 30 mins after (blood culture 3) transe sophageal echocardiography examinations, Measurements and Main Results : The mean duration of transesophageal echocardiography was 35 mins (r ange 7 to 120), One hundred thirty-four patients received mechanical v entilation; 125 patients had a nasogastric tube, Fifty-one patients ha d one or more underlying conditions that usually justify antimicrobial prophylaxis of bacterial endocarditis before high-risk procedures, Fi fty-six patients did not receive any antibiotic treatment at the time of transesophageal echocardiography, In 114 patients, the three blood cultures were negative, In six patients, transesophageal echocardiogra phy was performed during a preexisting bacteremia, A contamination (on ly one positive blood culture of the three sampling times) with coagul ase-negative staphylococci occurred in four patients at blood culture 1, five patients at blood culture 2, and six patients at blood culture 3. Contamination with Corynebacterium species occurred in two patient s at blood culture 2, In one patient receiving cefotaxime and netilmic in, blood culture 1 was sterile and blood cultures 2 and 3 yielded coa gulase-negative staphylococci, In one patient receiving no antibiotic treatment, blood culture 1 was sterile and blood cultures 2 and 3 yiel ded Enterococcus faecalis, None of these two patients received a speci fic antibiotic treatment or developed any secondary septic focus, Conc lusions: The overall frequency of bacteremia induced by transesophagea l echocardiography in ICU patients was 1.4% (two of 139 patients) (95% confidence interval 0.2% to 5.1%). The frequency did not differ wheth er patients received antibiotics before transesophageal echocardiograp hy (one [1.2%] of 83 patients) or not (one [1.8%] of 56 patients) (p = .96). Therefore, routine antimicrobial prophylaxis does not appear ju stified before transesophageal echocardiography in ICU patients.