311. The Role of Transthoracic Echocardiography in Staphylococcus aureus Bacteremia; A Retrospective Chart Review

BACKGROUND: Evaluation for endocarditis is an essential step in the management of patients with Staphylococcus aureus bacteremia (SAB). A common approach, consistent with preeminent national guidelines, is to perform transthoracic echocardiography (TTE) followed by transesophageal echocardiography (TEE) in the majority of patients with SAB. It is unclear how often patient management decisions are influenced by the results of TTE versus TEE. METHODS: This retrospective chart review of 180 subjects evaluated adult veterans at a single large Veterans Affairs medical center who had SAB and completed both TTE and TEE. Institution-specific guidelines at this medical center, which were in place throughout the study time period, recommended completion of both TTE and TEE for all patients diagnosed with SAB if able to tolerate both studies. The timing of key patient-management decisions was correlated to the timing of each patient’s TTE and TEE. It was then inferred whether each decision would have been informed by TTE alone versus TTE plus subsequent TEE. Management decisions included: initiation of synergistic antibiotics, documentation of antibiotic treatment duration, consultation of specialists such as Cardiology or Cardiac Surgery, and performance of valve surgery. RESULTS: Preliminary results show that management decisions were typically not performed until patients had undergone both echocardiography studies. In 18% of patients, management was deemed to be influenced in any capacity following TTE, compared to 91% following both TTE and TEE. CONCLUSION: Our findings question the utility of performing a TTE in patients with SAB who are planned to also undergo a subsequent TEE. DISCLOSURES: All Authors: No reported disclosures