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Point-of-Care Ultrasound (POCUS) as an Extension of the Physical Examination in Patients with Bacteremia or Candidemia. | LitMetric

AI Article Synopsis

  • Transthoracic echocardiography (TTE) is commonly the first test for diagnosing Infective Endocarditis (IE) in patients with bacteremia or candidemia, while point-of-care ultrasound (POCUS) can be used alongside physical exams to identify heart issues.
  • The study aimed to assess the accuracy of POCUS in detecting IE-related signs, like vegetation and valvular regurgitation, in a multicenter setting across six hospitals in Spain.
  • Results showed that POCUS had good sensitivity and specificity for detecting valvular vegetation and regurgitation, as well as for identifying hepatomegaly and splenomegaly, indicating its potential value as a bedside diagnostic tool for patients with these conditions

Article Abstract

Background: In general, transthoracic echocardiography (TTE) is the first diagnostic test used for patients with bacteremia or candidemia and clinical signs of Infective Endocarditis (IE). Point-of-care ultrasound (POCUS) may be used in addition to physical examination for the detection of structural heart disease and valve abnormalities.

Objective: To determine the diagnostic accuracy of POCUS for the detection of signs suggestive of IE, including vegetation, valvular regurgitation, structural heart disease, hepatomegaly, splenomegaly and septic embolisms, in patients with bacteremia or candidemia.

Design: Observational, cross-sectional, multicenter study using convenience sampling.

Setting: Six Spanish academic hospitals.

Patients: Adult patients with bacteremia or candidemia between 1 February 2018 and 31 December 2020.

Measurements: The reference test, to evaluate vegetation, valvular regurgitation and structural heart disease, was transesophageal echocardiography (TEE). For patients who did not undergo TEE, transthoracic echocardiography (TTE) was considered the reference test. POCUS was performed by internists, while conventional echocardiography procedures were performed by cardiologists.

Results: In 258 patients, for the detection of valvular vegetation, POCUS had sensitivity, specificity, and positive and negative predictive values of 77%, 94%, 82% and 92%, respectively. For valvular regurgitation (more than mild), sensitivity was ≥76% and specificity ≥85%. Sensitivity values for the detection of hepatomegaly and splenomegaly were 92% and 92%, respectively, while those for specificity were 96% and 98%.

Conclusion: POCUS could be a valuable tool, as a complement to physical examination, at the hospital bedside for patients with bacteremia or candidemia, helping to identify signs suggestive of IE.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9267352PMC
http://dx.doi.org/10.3390/jcm11133636DOI Listing

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