In Reply Dr Schoenfeld and colleagues emphasize the low quality of the available evidence regarding the use of transesophageal echocardiography in patients with S aureus bacteremia and the possibility that cases of endocarditis may have been missed in the relevant studies. We agree with this point and would welcome definitive high-quality studies to address this possibility.
A mandatory transesophageal echocardiography design seems unlikely to succeed on a practical basis; for example, in one study using that approach, only 59% of patients had it performed.1 A trial comparing a strategy of universal vs targeted transesophageal echocardiography, with attention to clinical outcomes, would be a pivotal contribution to the literature.
Holland TL, Fowler VG. Diagnosing Endocarditis in Patients With Staphylococcus aureus Bacteremia—Reply. JAMA. 2015;313(4):420-421. doi:10.1001/jama.2014.16954