Transthoracic echocardiography in children with Staphylococcus aureus bacteraemia: a multi-centre retrospective analysis
File(s)
Published version
Author(s)
Gray, Kirsty
Ahad, Farhana
Cunnington, Aubrey
Type
Journal Article
Abstract
Background: Staphylococcus aureus bacteraemia (SAB) is associated with risk of infective endocarditis (IE). In children, IE is rare in the absence of known risk factors such as congenital heart disease. Extrapolating from adult practice, routine transthoracic echocardiography (TTE) is often performed for children with SAB despite limited age-specific evidence to support this practice. Identifying children who can safely forgo TTE could reduce unnecessary investigations, costs, and length of hospital stay.
Methods: This multi-centre retrospective cohort study included 101 children (0 to ≤18 years) with SAB across six Northwest London hospitals (2018–2023). We collected clinical, microbiological, and echocardiographic data from electronic patient records. Exact logistic regression was employed for rare events analysis with non-parametric comparisons between groups.
Results: Of 101 children, the median age was 4.3 (range 0.0–17.6) years and 60 (59%) were male. 71 (70%) underwent TTE and 30 (30%) did not. IE was confirmed in 4 (5.6%) of the 71 children undergoing TTE. All children with IE had established risk factors: congenital heart disease (2/4), intravenous drug use (1/4), or central venous catheters (2/4); all four IE cases were right-sided. The TTE group had longer hospital stays than the no-TTE group (median 17 vs 4 days, p=0.0020). Acute in-hospital mortality occurred in 1/71 of the TTE group versus 0/30 of the no-TTE group (p=1.0). Among children undergoing TTE, features associated with IE versus no IE included embolic phenomena (75% vs 1.5%, p<0.001), higher CRP (median 237 vs 124 mg/L, p=0.083), persistent bacteraemia at >72 hours (67% vs 4.9%, p=0.018), and polymicrobial growth on blood culture (50% vs 6%, p=0.033).
Conclusion: Our findings support a risk-stratified rather than universal approach to TTE in paediatric SAB. TTE could reasonably be omitted in children with SAB who have a structurally normal heart, no established IE risk factor, and no clinical feature suggestive of IE; conversely, TTE should be performed when embolic phenomena, persistent bacteraemia, polymicrobial growth, or a pre-existing murmur are present, and retained in children with established risk factors (congenital heart disease, intravenous drug use, or central venous catheters), in whom all four cases of IE in our cohort occurred. Prospective multi-centre validation of a structured risk-stratification tool is needed before such an approach can be adopted in routine practice.
Methods: This multi-centre retrospective cohort study included 101 children (0 to ≤18 years) with SAB across six Northwest London hospitals (2018–2023). We collected clinical, microbiological, and echocardiographic data from electronic patient records. Exact logistic regression was employed for rare events analysis with non-parametric comparisons between groups.
Results: Of 101 children, the median age was 4.3 (range 0.0–17.6) years and 60 (59%) were male. 71 (70%) underwent TTE and 30 (30%) did not. IE was confirmed in 4 (5.6%) of the 71 children undergoing TTE. All children with IE had established risk factors: congenital heart disease (2/4), intravenous drug use (1/4), or central venous catheters (2/4); all four IE cases were right-sided. The TTE group had longer hospital stays than the no-TTE group (median 17 vs 4 days, p=0.0020). Acute in-hospital mortality occurred in 1/71 of the TTE group versus 0/30 of the no-TTE group (p=1.0). Among children undergoing TTE, features associated with IE versus no IE included embolic phenomena (75% vs 1.5%, p<0.001), higher CRP (median 237 vs 124 mg/L, p=0.083), persistent bacteraemia at >72 hours (67% vs 4.9%, p=0.018), and polymicrobial growth on blood culture (50% vs 6%, p=0.033).
Conclusion: Our findings support a risk-stratified rather than universal approach to TTE in paediatric SAB. TTE could reasonably be omitted in children with SAB who have a structurally normal heart, no established IE risk factor, and no clinical feature suggestive of IE; conversely, TTE should be performed when embolic phenomena, persistent bacteraemia, polymicrobial growth, or a pre-existing murmur are present, and retained in children with established risk factors (congenital heart disease, intravenous drug use, or central venous catheters), in whom all four cases of IE in our cohort occurred. Prospective multi-centre validation of a structured risk-stratification tool is needed before such an approach can be adopted in routine practice.
Date Issued
2026-06-19
Date Acceptance
2026-06-04
Citation
BMJ Paediatrics Open, 2026, 10 (1)
ISSN
2399-9772
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Paediatrics Open
Volume
10
Issue
1
Copyright Statement
© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license.
License URL
Identifier
10.1136/bmjpo-2025-004466
Subjects
Gray K
Ahad F
Cunnington A. Transthoracic echocardiography in children with Staphylococcus aureus bacteraemia: a multi-centre retrospective analysis
Publication Status
Published
Article Number
004466
Date Publish Online
2026-06-19