# The Effect of Transesophageal Echocardiogram on Clinical Outcomes for Patients with Staphylococcus aureus Bloodstream Infection

## TL;DR

This study found that fewer transesophageal echocardiograms were performed during the pandemic for bloodstream infections, but most outcomes stayed the same except higher mortality.

## Contribution

The study reveals the impact of reduced transesophageal echocardiogram use during the pandemic on bloodstream infection outcomes.

## Key findings

- Fewer transesophageal echocardiograms were performed during the pandemic (72% vs. 50.9%).
- Ninety-day mortality was higher in the pandemic group (10.4% vs. 22.2%).
- Confirmed endocarditis rates and antibiotic duration were similar between groups.

## Abstract

Background/Objectives: Staphylococcus aureus bloodstream infections (SABSIs) are associated with significant morbidity and mortality and are often complicated by infective endocarditis (IE). During the COVID-19 pandemic, fewer transesophageal echocardiographs (TEEs) were performed for patients diagnosed with SABSI, and this study examined the impact on clinical outcomes associated with this change in practice. Methods: This retrospective observational study included adult patients treated for SABSI who were admitted pre-COVID-19 (1 March 2018 to 11 March 2020) and during COVID-19 (12 March 2020 to 1 March 2022). Primary outcomes were rates of confirmed IE and duration of antibiotic therapy (DOT). Results: Of 333 screened patients, 214 were included (107 per group). Patients in the COVID-19 group were older (51.49 vs. 56.31 years, p = 0.013); other baseline characteristics were similar. Catheter-related infections were the most common source in the pre-COVID-19 and COVID-19 groups (30.8% vs. 18.9%, p = 0.089). Rates of TEE procedures significantly declined during COVID-19 (72% vs. 50.9%, p = 0.002); rate of confirmed IE (9.4% vs. 12.1%; p = 0.660) and median DOT (28 vs. 28 days; p = 0.596) were similar. Ninety-day mortality was higher in the COVID-19 group (10.4% vs. 22.2%, p = 0.019); other outcomes were not statistically different. Conclusions: The COVID-19 pandemic led to a notable decline in TEEs performed for SABSI, but the majority of clinical outcomes were unchanged. Mortality was significantly higher in the COVID-19 group, but it is uncertain that this was solely due to the change in practices. In a healthcare system that universally recommends TEE, scoring systems may help identify which patients are highest priority for TEE versus those that could undergo a transthoracic echocardiogram.