Enterococcus faecalis bacteremia: please do the echo

Infective endocarditis (IE) caused by Enterococcus faecalis (E. faecalis) is a disease of the elderly with an increasing incidence, often health-care associated and with in-hospital mortality rates around 10-20%. E. faecalis IE is notoriously challenging to diagnose due to unspecific symptoms, often presenting with a complex clinical picture with low-grade fever and only moderately elevated infectious parameters. In a newly published prospective multicenter study using echocardiography to screen E. faecalis bacteremia patients, we found an IE prevalence as high as 26%. The 344 included patients with E. faecalis bacteremia had a mean age of 74 (±12) years confirming that it is indeed a disease of the elderly. The key feature of the study was that echocardiography was performed in all patients including transesophageal echocardiography (TEE) in 74%. Transthoracic echocardiography (TTE) missed vegetations in half of the cases where TEE demonstrated vegetations, underlining the importance of TEE