Assessing Need for Transesophageal Echocardiography in Clinically Improving Patients at Risk for Infective Endocarditis: A Preliminary Retrospective Cohort Study in a Community Based Health System

Background Transesophageal echocardiogram is the preferred imaging modality for definitive diagnosis of infective endocarditis. However, some cases don’t always necessitate its use, especially among non-surgical, clinically improving patients on antibiotics. Methods A preliminary retrospective cohort study was performed on 134 patients within a 2-hospital community-based health system from March 2024 to June 2024. Results 68 were male (50.7%) and 66 were female (49.3%) with median age of 71 years. 41% of patients were treated with predetermined long-term antibiotics for infective endocarditis, and 71% of those were non-surgical candidates and clinically improving (defervesced in less than 3 days/remained afebrile and had resolving/resolved white blood count). Transesophageal echocardiogram use did not significantly change predetermined long-term antibiotic management among non-surgical, clinically improving patients. Predetermined long-term antibiotic treatment was found to be significantly associated with patients having a definitive infective endocarditis diagnosis (p < 0.001). Repeat positive sets of blood cultures and failure to defervesce less than 3 days were shown to be significant clinical predictors of infective endocarditis (p < 0.001 and p = 0.015 respectively) and increased transesophageal echocardiography use (p < 0.001 and p = 0.045 respectively). Conclusions Overall, the study suggests that transesophageal echocardiography may not be necessary in non-surgically indicated clinically improving patients at risk for infective endocarditis, as management did not significantly change. However, if objective guidance is needed for transesophageal echocardiogram use, repeating positive blood cultures for gram positive organisms and failure to defervesce in less than 3 days may be useful.