In patients with Staphylococcus aureus bacteremia, which evaluation is commonly recommended due to risk of metastatic infection such as endocarditis or vertebral osteomyelitis?

• A. Abdominal ultrasound
• B. Chest X-ray
• C. Echocardiography
• D. Brain MRI

Answer: (C)

Staphylococcus aureus bacteremia carries a real and serious risk of spreading to distant sites, especially the heart valves, causing infective endocarditis. Echocardiography is the imaging test used to detect vegetations and assess valve involvement, which directly influences management. Early echocardiographic evaluation—often starting with transthoracic imaging and moving to transesophageal imaging if needed—is recommended because identifying endocarditis changes antibiotic duration, the need for more aggressive therapy, and the possibility of surgical intervention.

Other tests like abdominal ultrasound, Chest X-ray, or brain MRI assess other complications or sources of infection, but they do not evaluate the primary metastatic risk of endocarditis. Vertebral osteomyelitis would be evaluated with spine MRI if suspected, but the key screening step in this scenario is echocardiography to rule in or out endocarditis.