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Time to blood culture positivity in Staphylococcus aureus bacteraemia to determine risk of infective endocarditis

Kahn, Fredrik LU ; Resman, Fredrik LU ; Bergmark, Sissela ; Filiptsev, Peter ; Nilson, Bo LU orcid ; Gilje, Patrik LU and Rasmussen, Magnus LU orcid (2021) In Clinical Microbiology and Infection 27(9). p.7-1345
Abstract

Objectives: Patients with Staphylococcus aureus bacteraemia (SAB) at risk for infective endocarditis (IE) need to be identified because they should undergo echocardiography. We validated previous scoring systems for IE risk determination and evaluated whether time to blood culture positivity (TTP) could improve scoring systems. Methods: This retrospective population-based study included adults with SAB in 2016 in a derivation cohort and those from 2017 in a validation cohort. TTP was compared between patients with and without IE. A new score including TTP was constructed using a least absolute shrinkage selection operator. The new POSITIVE score was compared to the previously described PREDICT and VIRSTA scores. Results: A total of 465... (More)

Objectives: Patients with Staphylococcus aureus bacteraemia (SAB) at risk for infective endocarditis (IE) need to be identified because they should undergo echocardiography. We validated previous scoring systems for IE risk determination and evaluated whether time to blood culture positivity (TTP) could improve scoring systems. Methods: This retrospective population-based study included adults with SAB in 2016 in a derivation cohort and those from 2017 in a validation cohort. TTP was compared between patients with and without IE. A new score including TTP was constructed using a least absolute shrinkage selection operator. The new POSITIVE score was compared to the previously described PREDICT and VIRSTA scores. Results: A total of 465 episodes with SAB were included in the derivation cohort, of which 38 (8.2%) represented IE. Median (interquartile range) TTP was significantly shorter in episodes with IE, at 8.7 (7.7–10.6) hours compared to those without, at 13.3 (10.5–16.5) hours. When using a cutoff at 13 hours, TTP had a sensitivity of 100% (95% confidence interval (CI), 91–100) and specificity of 52% (95% CI, 47–57) for IE. The POSITIVE score included TTP, intravenous drug use, embolizations and presence of preexisting heart conditions. It had a sensitivity of 93% (95% CI, 76–99) and a specificity of 70% (95% CI, 66–74) in the validation cohort. The performance of POSITIVE was superior to PREDICT, and the specificity was higher than that of VIRSTA. Conclusions: TTP, either by itself or as part of the POSITIVE score, can be used to identify patients with SAB at low risk for IE. Further validation is needed because TTP is sensitive to several external factors.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Bacteraemia, Infective endocarditis, Staphylococcus aureus, Time to positivity
in
Clinical Microbiology and Infection
volume
27
issue
9
pages
7 - 1345
publisher
Wiley-Blackwell
external identifiers
  • pmid:33197608
  • scopus:85097046713
ISSN
1198-743X
DOI
10.1016/j.cmi.2020.11.007
language
English
LU publication?
yes
id
1d61e3ca-9e54-4999-a858-0cd58a1b4e94
date added to LUP
2021-01-11 16:15:45
date last changed
2025-01-24 03:44:50
@article{1d61e3ca-9e54-4999-a858-0cd58a1b4e94,
  abstract     = {{<p>Objectives: Patients with Staphylococcus aureus bacteraemia (SAB) at risk for infective endocarditis (IE) need to be identified because they should undergo echocardiography. We validated previous scoring systems for IE risk determination and evaluated whether time to blood culture positivity (TTP) could improve scoring systems. Methods: This retrospective population-based study included adults with SAB in 2016 in a derivation cohort and those from 2017 in a validation cohort. TTP was compared between patients with and without IE. A new score including TTP was constructed using a least absolute shrinkage selection operator. The new POSITIVE score was compared to the previously described PREDICT and VIRSTA scores. Results: A total of 465 episodes with SAB were included in the derivation cohort, of which 38 (8.2%) represented IE. Median (interquartile range) TTP was significantly shorter in episodes with IE, at 8.7 (7.7–10.6) hours compared to those without, at 13.3 (10.5–16.5) hours. When using a cutoff at 13 hours, TTP had a sensitivity of 100% (95% confidence interval (CI), 91–100) and specificity of 52% (95% CI, 47–57) for IE. The POSITIVE score included TTP, intravenous drug use, embolizations and presence of preexisting heart conditions. It had a sensitivity of 93% (95% CI, 76–99) and a specificity of 70% (95% CI, 66–74) in the validation cohort. The performance of POSITIVE was superior to PREDICT, and the specificity was higher than that of VIRSTA. Conclusions: TTP, either by itself or as part of the POSITIVE score, can be used to identify patients with SAB at low risk for IE. Further validation is needed because TTP is sensitive to several external factors.</p>}},
  author       = {{Kahn, Fredrik and Resman, Fredrik and Bergmark, Sissela and Filiptsev, Peter and Nilson, Bo and Gilje, Patrik and Rasmussen, Magnus}},
  issn         = {{1198-743X}},
  keywords     = {{Bacteraemia; Infective endocarditis; Staphylococcus aureus; Time to positivity}},
  language     = {{eng}},
  month        = {{09}},
  number       = {{9}},
  pages        = {{7--1345}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Clinical Microbiology and Infection}},
  title        = {{Time to blood culture positivity in Staphylococcus aureus bacteraemia to determine risk of infective endocarditis}},
  url          = {{http://dx.doi.org/10.1016/j.cmi.2020.11.007}},
  doi          = {{10.1016/j.cmi.2020.11.007}},
  volume       = {{27}},
  year         = {{2021}},
}