Infective endocarditis (IE) has been increasingly recognized as an important complication of Staphylococcus aureus bacteremia (SAB), leading to a low threshold for echocardiography and extended treatment with anti-staphylococcal agents. However, outside of IE, many indications for prolonged anti-staphylococcal therapy courses are present. We sought to determine the frequency in which findings from a transesophageal echocardiogram (TEE) changed clinical SAB management in a large Canadian health region. Residents (> 18 years) with SAB from 2012 to 2014 who underwent transthoracic echocardiogram (TTE) and TEE were assessed. Patients potentially benefiting from an extended course of anti-staphylococcal agents were defined a priori. Patient demographics, treatment (including surgical), and clinical outcomes were extracted and evaluated. Of the 705 episodes of SAB that underwent a screening echocardiogram, 203 episodes underwent both a TTE and TEE, of which 92.1% (187/203) contained an a priori indication for extended anti-staphylococcal therapy. Regardless of TEE results, actual duration of therapy did not differ in SAB episodes that had ≥ 1 extended anti-staphylococcal therapy criteria (36.7 days, IQR 23.4–48.6 vs. 43.8 days, IQR 33.3–49.5, p = 0.17). Additionally, there were no cases in which TEE was utilized as the sole reason to shorten duration of therapy or proceed to surgery for those with SAB. Routine performance of TEE may be unnecessary in all SAB as many patients have pre-existing indications for extended anti-staphylococcal therapy independent of TEE findings. An algorithm to selectively identify cases of SAB that would benefit from TEE can reduce resource and equipment expenditure and patient risks associated with TEE.

感染性心内膜炎（IE）越来越被认为是金黄色葡萄球菌的重要并发症菌血症 (SAB)，导致超声心动图的低阈值和抗葡萄球菌药物的延长治疗。然而，在 IE 之外，存在许多延长抗葡萄球菌治疗疗程的适应症。我们试图确定经食道超声心动图 (TEE) 的结果在加拿大一个大型健康地区改变临床 SAB 管理的频率。对 2012 年至 2014 年接受经胸超声心动图 (TTE) 和 TEE 的 SAB 居民（> 18 岁）进行了评估。潜在受益于抗葡萄球菌药物延长疗程的患者被预先定义。提取和评估患者人口统计学、治疗（包括手术）和临床结果。在接受筛查超声心动图的 705 次 SAB 发作中，203 次接受了 TTE 和 TEE，其中 92 次。1% (187/203) 包含延长抗葡萄球菌治疗的先验适应症。无论 TEE 结果如何，在具有 ≥ 1 项延长抗葡萄球菌治疗标准（36.7 天，IQR 23.4-48.6 与 43.8 天，IQR 33.3-49.5，p  = 0.17）。此外，没有任何病例将 TEE 作为缩短治疗持续时间或对 SAB 患者进行手术的唯一原因。在所有 SAB 中，TEE 的常规检查可能是不必要的，因为许多患者有独立于 TEE 发现的延长抗葡萄球菌治疗的预先存在的适应症。一种选择性地识别将从 TEE 中受益的 SAB 病例的算法可以减少与 TEE 相关的资源和设备支出以及患者风险。