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Clin Infect Dis. 2019 Jan 7. doi: 10.1093/cid/ciz014. [Epub ahead of print]

Risk-benefit assessment of systematic thoracoabdominopelvic CT scan in infective endocarditis.

Author information

1
Department of Infectious Disease, CHU Hôtel-Dieu, Nantes, France.
2
CIC UIC 1413 INSERM, CHU Nantes, France.
3
Intensive Care and Infectious Disease Unit, Groupe Saint-André, CHU Bordeaux, Bordeaux, France.
4
Department of Cardiology, Institut du Thorax, University Hospital, Nantes, France.
5
Department of Thoracic and Cardiovascular Surgery, Institut du Thorax, University Hospital, Nantes, France.
6
Anaesthesiology, University Hospital, Nantes, France.

Abstract

Background:

In the management of Infective Endocarditis (IE), the presence of extracardiac complications has an influence on both diagnosis and treatment. Current guidelines suggest that systematic thoraco-abdomino-pelvic CT scan (TAP-CT) may be helpful. Our objective was to describe how systematic TAP-CT affects the diagnosis and the management of IE.

Methods:

In this multicenter cohort study, between January 2013 and July 2016 we included consecutive patients who had definite or possible IE according to the Duke-modified criteria, validated by endocarditis teams. We analyzed whether the Duke classification and the therapeutic management were modified regarding the presence or the absence of IE-related lesion on the CT and investigated the tolerance of this exam.

Results:

Of the 522 patients included in this study, 217 (41.6%) had one or more IE-related lesion. On the basis of CT results in asymptomatic patients, diagnostic classification was upgraded from possible endocarditis to definite endocarditis for only 4 cases (0.8%). The presence of IE-related lesion on CT did not modify the duration of antibiotic treatment (p=0.55), nor the decision of surgical treatment (p=0.39). Specific treatment of the lesion was necessary in 42 patients (8.0%) but only 9 of these lesions (1.9%) were asymptomatic and diagnosed only on the TAP-CT. Acute kidney injury (AKI) within 5 days of the CT was observed in 78 patients (14.9%).

Conclusions:

The TAP-CT findings slightly affected diagnosis and treatment of IE in a very small proportion of asymptomatic patients. Furthermore, contrast media should be used with caution because of the high risk of AKI.

PMID:
30615098
DOI:
10.1093/cid/ciz014

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