Transthoracic Echocardiography Utilization in Pediatric Patients with Staphylococcus aureus Bacteraemia: A Retrospective Study Across Multiple Centers

By
Kirsty Gray
Farhana Ahad
Aubrey Cunnington
June 19, 2026

Bmj Paediatrics Open

Overview

This study evaluated the utilization of transthoracic echocardiography (TTE) in pediatric patients with Staphylococcus aureus bacteraemia (SAB), finding that 5.6% of children undergoing TTE were diagnosed with infective endocarditis (IE), all with established risk factors.

Background

Staphylococcus aureus bacteraemia (SAB) poses a risk for developing infective endocarditis (IE), particularly in children with known risk factors. Understanding the appropriate use of TTE could optimize resource allocation and patient management.

Data Highlights

Group	TTE (n=71)	No TTE (n=30)
IE Diagnosed	4 (5.6%)	0
Median Hospital Stay (days)	17	4
Acute In-Hospital Mortality	1	0
Embolic Phenomena	75%	1.5%
Persistent Bacteraemia >72 hours	67%	4.9%
Polymicrobial Growth	50%	6%

Key Findings

70% of children with SAB underwent TTE.
IE was confirmed in 5.6% of children undergoing TTE, all with established risk factors.
The TTE group had a significantly longer median hospital stay compared to the no-TTE group (17 vs 4 days).
Embolic phenomena were significantly more common in the TTE group (75% vs 1.5%).
Persistent bacteraemia at >72 hours was observed in 67% of the TTE group compared to 4.9% in the no-TTE group.
Polymicrobial growth on blood culture was found in 50% of the TTE group versus 6% in the no-TTE group.

Clinical Implications

The findings suggest that TTE may be unnecessary in children with SAB who have no established risk factors for IE. A risk-stratified approach could help identify which patients require TTE, potentially reducing unnecessary procedures and hospital stays.

Conclusion

The study advocates for a risk-stratified approach to TTE in pediatric patients with SAB, emphasizing the need for prospective validation before routine changes in practice.