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Comment & Response
January 27, 2015

Diagnosing Endocarditis in Patients With Staphylococcus aureus Bacteremia—Reply

Author Affiliations
  • 1Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, North Carolina
JAMA. 2015;313(4):420-421. doi:10.1001/jama.2014.16954

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.

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