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Risk stratification score screening for infective endocarditis in patients with Gram-positive bacteraemia

Lindberg, Helena LU ; Löfström, Emma LU and Rasmussen, Magnus LU (2022) In Infectious Diseases 54(7). p.488-496
Abstract

Background: A feared cause of bacteraemia with Gram-positives is infective endocarditis. Risk stratification scores can aid clinicians in determining the risk of endocarditis. Six proposed scores for the use in bacteraemia; Staphylococcus aureus (PREDICT, VIRSTA, POSITIVE), non-β-haemolytic streptococci (HANDOC) and Enterococcus faecalis (NOVA, DENOVA) were validated for predictive ability and the utilization of echocardiography was investigated. Methods: Hospitalized adult patients with Gram-positive bacteraemia during 2017–2019 were evaluated retrospectively through medical records and the Swedish Death Registry. Baseline and score-specific data, definite endocarditis and echocardiographies performed were recorded. Sensitivity,... (More)

Background: A feared cause of bacteraemia with Gram-positives is infective endocarditis. Risk stratification scores can aid clinicians in determining the risk of endocarditis. Six proposed scores for the use in bacteraemia; Staphylococcus aureus (PREDICT, VIRSTA, POSITIVE), non-β-haemolytic streptococci (HANDOC) and Enterococcus faecalis (NOVA, DENOVA) were validated for predictive ability and the utilization of echocardiography was investigated. Methods: Hospitalized adult patients with Gram-positive bacteraemia during 2017–2019 were evaluated retrospectively through medical records and the Swedish Death Registry. Baseline and score-specific data, definite endocarditis and echocardiographies performed were recorded. Sensitivity, specificity, negative and positive predictive values and echocardiography utilization were determined. Results: 480 patients with bacteraemia were included and definite endocarditis was diagnosed in 20 (7.5%), 10 (6.6%), and 2 (3.2%) patients with S. aureus, non-β-haemolytic streptococci and E. faecalis, respectively. The sensitivities of the scores were 80–100% and specificities 8–77%. Negative predictive values of the six scores were 98–100%. VIRSTA, HANDOC, NOVA and DENOVA identified all, the PREDICT5 score missed 1/20 and the POSITIVE score missed 4/20 cases of endocarditis. Transoesophageal echocardiography was performed in 141 patients (29%). Thus, the risk stratification scores suggested an increase of 3–63 (7–77%) investigations with echocardiography. Conclusions: All scores had negative-predictive values over 98%, therefore it can be concluded that PREDICT5, VIRSTA, POSITIVE, HANDOC and DENOVA are reasonable screening tools for endocarditis early on in Gram-positive bacteraemia. The use of risk stratification scores will lead to more echocardiographies.

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author
; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Enterococcus faecalis, Infective endocarditis, non-β-haemolytic Streptococcus, risk stratification score, Staphylococcus aureus, transoesophageal echocardiography (TEE)
in
Infectious Diseases
volume
54
issue
7
pages
488 - 496
publisher
Informa Healthcare
external identifiers
  • pmid:35277116
  • scopus:85126511821
ISSN
2374-4235
DOI
10.1080/23744235.2022.2049360
language
English
LU publication?
yes
id
fcbe5a03-0da7-4a23-ad14-4ea3d4fc89f9
date added to LUP
2022-05-10 11:52:54
date last changed
2024-09-06 20:02:16
@article{fcbe5a03-0da7-4a23-ad14-4ea3d4fc89f9,
  abstract     = {{<p>Background: A feared cause of bacteraemia with Gram-positives is infective endocarditis. Risk stratification scores can aid clinicians in determining the risk of endocarditis. Six proposed scores for the use in bacteraemia; Staphylococcus aureus (PREDICT, VIRSTA, POSITIVE), non-β-haemolytic streptococci (HANDOC) and Enterococcus faecalis (NOVA, DENOVA) were validated for predictive ability and the utilization of echocardiography was investigated. Methods: Hospitalized adult patients with Gram-positive bacteraemia during 2017–2019 were evaluated retrospectively through medical records and the Swedish Death Registry. Baseline and score-specific data, definite endocarditis and echocardiographies performed were recorded. Sensitivity, specificity, negative and positive predictive values and echocardiography utilization were determined. Results: 480 patients with bacteraemia were included and definite endocarditis was diagnosed in 20 (7.5%), 10 (6.6%), and 2 (3.2%) patients with S. aureus, non-β-haemolytic streptococci and E. faecalis, respectively. The sensitivities of the scores were 80–100% and specificities 8–77%. Negative predictive values of the six scores were 98–100%. VIRSTA, HANDOC, NOVA and DENOVA identified all, the PREDICT5 score missed 1/20 and the POSITIVE score missed 4/20 cases of endocarditis. Transoesophageal echocardiography was performed in 141 patients (29%). Thus, the risk stratification scores suggested an increase of 3–63 (7–77%) investigations with echocardiography. Conclusions: All scores had negative-predictive values over 98%, therefore it can be concluded that PREDICT5, VIRSTA, POSITIVE, HANDOC and DENOVA are reasonable screening tools for endocarditis early on in Gram-positive bacteraemia. The use of risk stratification scores will lead to more echocardiographies.</p>}},
  author       = {{Lindberg, Helena and Löfström, Emma and Rasmussen, Magnus}},
  issn         = {{2374-4235}},
  keywords     = {{Enterococcus faecalis; Infective endocarditis; non-β-haemolytic Streptococcus; risk stratification score; Staphylococcus aureus; transoesophageal echocardiography (TEE)}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{488--496}},
  publisher    = {{Informa Healthcare}},
  series       = {{Infectious Diseases}},
  title        = {{Risk stratification score screening for infective endocarditis in patients with Gram-positive bacteraemia}},
  url          = {{http://dx.doi.org/10.1080/23744235.2022.2049360}},
  doi          = {{10.1080/23744235.2022.2049360}},
  volume       = {{54}},
  year         = {{2022}},
}