Risk stratification score screening for infective endocarditis in patients with Gram-positive bacteraemia
(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.
(Less)
- author
- Lindberg, Helena LU ; Löfström, Emma LU and Rasmussen, Magnus LU
- organization
- publishing date
- 2022
- 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}},
}