From the Guidelines
Gram-positive bacilli bacteremia does not routinely require an echocardiogram for all patients, but the decision to obtain one should be based on specific clinical factors such as persistent bacteremia, presence of a cardiac murmur, predisposing valvular heart disease, implanted cardiac devices, or clinical signs suggesting endocarditis. The most recent and highest quality study, 1, suggests that US echocardiography transthoracic resting, radiography chest, or CT heart function and morphology with IV contrast is usually appropriate for the initial imaging of suspected infective endocarditis.
Some key points to consider when deciding whether to obtain an echocardiogram include:
- The presence of persistent bacteremia or clinical signs suggesting endocarditis
- The presence of a cardiac murmur or predisposing valvular heart disease
- The presence of implanted cardiac devices
- The specific organism involved, with certain gram-positive bacilli like Listeria monocytogenes having a higher risk of endocarditis
- The duration and severity of bacteremia, as well as the patient's underlying conditions
If there is concern for endocarditis, a transthoracic echocardiogram (TTE) is typically performed first, with transesophageal echocardiography (TEE) reserved for cases where TTE is negative but clinical suspicion remains high or when better visualization is needed, as recommended by 1 and 1. It's also important to note that echocardiography should be considered in Staphylococcus aureus bacteremia, as stated in 1.
In terms of the type of echocardiogram to perform, 1 recommends that TEE is preferred over TTE for adult patients with bacteremia. However, the choice of echocardiogram should be based on the individual patient's clinical factors and the suspected likelihood of endocarditis.
Ultimately, the decision to obtain an echocardiogram should be made on a case-by-case basis, taking into account the individual patient's clinical factors and the suspected likelihood of endocarditis, as recommended by 1 and 1.
From the Research
Gram Positive Bacilli Bacteremia and Echo
- The provided studies primarily focus on Gram-positive cocci bacteremia and the risk of infective endocarditis (IE), rather than Gram-positive bacilli bacteremia.
- However, the general principles of assessing the risk of IE and the use of echocardiography may still be applicable.
- According to 2, routine echocardiography is recommended in patients with high-risk bacteremia, but the study specifically looks at Gram-positive cocci.
- 3 discusses the risk stratification systems for IE in gram-positive bacteraemia and the use of echocardiography, but again, focuses on Gram-positive cocci.
- 4 and 5 examine the use of echocardiography in patients with Staphylococcus aureus bacteraemia, which is a type of Gram-positive cocci, and suggest that echocardiography may not be necessary for patients at low risk of endocarditis.
- 6 highlights the importance of echocardiography in the diagnosis of IE, but does not specifically address Gram-positive bacilli bacteremia.
Echocardiography in Bacteremia
- There is no direct evidence in the provided studies to suggest that Gram-positive bacilli bacteremia necessarily requires an echo.
- However, the studies do emphasize the importance of assessing the risk of IE and using echocardiography in patients with high-risk bacteremia.
- It is possible that the principles outlined in these studies could be applied to Gram-positive bacilli bacteremia, but more specific research would be needed to confirm this.
- In general, the decision to perform an echo in patients with bacteremia should be based on an individualized assessment of the patient's risk factors and clinical presentation, as suggested by 3 and 4.