To the Editor Dr Holland and colleagues1 performed a systematic review of the clinical management of patients with Staphylococcus aureus bacteremia and concluded that for those with certain low-risk characteristics, transesophageal echocardiography can be safely deferred. Our objection to this assertion is 2-fold.
First, we agree with the authors’ assessment that the available evidence is low quality. In particular, the relevant studies used a reference standard that was less sensitive than it could have been, in that there were low rates of transesophageal echocardiography performed. Thus, some cases of endocarditis could have been missed and falsely labeled as having no endocarditis.
Schoenfeld M, Machhar R, Maw A. Diagnosing Endocarditis in Patients With Staphylococcus aureus Bacteremia. JAMA. 2015;313(4):420. doi:10.1001/jama.2014.16951