Predicting Risk of Endocarditis Using a Clinical Tool (PREDICT): Scoring System to Guide Use of Echocardiography in the Management of Staphylococcus aureus Bacteremia.
Clin Infect Dis. 2015 Mar 25;
Authors: Palraj BR, Baddour LM, Hess EP, Steckelberg JM, Wilson WR, Lahr BD, Sohail MR
Abstract
BACKGROUND: Infective endocarditis (IE) is a serious complication of Staphylococcus aureus bacteremia (SAB). There is limited clinical evidence to guide use of echocardiography in the management of SAB cases.
METHODS: Baseline and 12-week follow-up data of all adults hospitalized at our institution with SAB from 2006 to 2011 were reviewed. Clinical predictors of IE were identified using multivariable logistic regression analysis.
RESULTS: Of the 757 patients screened, 678 individuals with SAB (24% community-acquired, 56% healthcare-associated and 20% nosocomial) met study criteria. Eighty-five patients (13%) were diagnosed with definite IE within the 12 weeks of initial presentation based on modified Duke criteria. The proportion of patients with IE was 22% (36/166) in community-acquired SAB, 11% (40/378) in community-onset healthcare associated and 7% (9/136) in nosocomial SAB. Community-acquired- SAB, presence of cardiac device, and prolonged bacteremia (≥ 72h) were identified as independent predictors of IE in multivariable analysis. Two scoring systems; "Day 1" (SAB diagnosis day) and "Day 5" (when day 3 culture results are known) were derived based on the presence of these risk factors, weighted in magnitude by the corresponding regression coefficients. A score of≥4 for Day 1 model had a specificity of 96% and sensitivity of 21% whereas a score of <2 for Day 5 model had a sensitivity of 98.8% and negative predictive value (NPV) of 98.5%.
CONCLUSIONS: We propose two novel scoring systems to guide use of echocardiography in SAB cases. Larger prospective studies are needed to validate the classification performance of these scoring systems.
PMID: 25810284 [PubMed - as supplied by publisher]