Infective endocarditis due to Staphylococcus aureus: 59 prospectively identified cases with follow-up

Fifty-nine consecutive patients with definite Staphylococcus aureus infecti ve endocarditis (IE) by the Duke criteria were prospectively identified at our hospital over a 3-year period. Twenty-seven (45.8%) of the 59 patients had hospital-acquired S, aureus bacteremia. The presumed source of infectio n was an intravascular device in 50.8% of patients. Transthoracic echocardi ography (TTE) revealed evidence of IE in 20 patients (33.9%), whereas trans esophageal echocardiography (TEE) revealed evidence of IE in 48 patients (8 1.4%). The outcome for patients was strongly associated with echocardiograp hic findings: 13 (68.4%) of 19 patients with vegetations visualized by TTE had an embolic event or died of their infection vs. five (16.7%) of 30 pati ents whose vegetations were visualized only by TEE (P <.01). Most patients with S, aureus IE developed their infection as a consequence of a nosocomia l or intravascular device-related infection. TEE established the diagnosis of S, aureus IE in many instances when TTE was nondiagnostic. Visualization of vegetations by TTE may provide prognostic information for patients with S, aureus 1E.