A 48-year-old man on ICU has a central line-associated bloodstream infection with methicillin-resistant Staphylococcus aureus (MRSA). The line has bee...

Question

A 48-year-old man on ICU has a central line-associated bloodstream infection with methicillin-resistant Staphylococcus aureus (MRSA). The line has been removed and IV vancomycin started. Blood cultures at day 3 remain positive for MRSA. At what point should the team perform a transoesophageal echocardiogram (TOE) to exclude endocarditis?

Accepted Answer

TOE should be performed for ALL patients with S. aureus bacteraemia - IDSA and BSH guidelines recommend TOE for all SAB because of the 10-25% incidence of infective endocarditis; if blood cultures remain positive at 72 hours, the risk is even higher and TOE is mandatory

Answer

TOE is never needed for MRSA bacteraemia

Answer

Only if the patient has a prosthetic valve

Answer

Only after 14 days of positive cultures

Answer

Transthoracic echo is always sufficient

uk-fficm MCQ (SBA): MRSA Bacteraemia - TOE