Prediction rules for ruling out endocarditis in patients with Staphylococcus aureus bacteremia

Link to article at PubMed

Clin Infect Dis. 2021 Jul 16:ciab632. doi: 10.1093/cid/ciab632. Online ahead of print.


BACKGROUND: Staphylococcus aureus bacteremia (SAB) is in 10% to 20% of cases complicated by infective endocarditis (SA-IE). Clinical prediction scores may select SAB patients at highest risk for endocarditis, improving the diagnostic process of endocarditis. We compared the accuracy of the POSITIVE, PREDICT and VIRSTA scores for classifying the likelihood of endocarditis in SAB patients.

METHODS: Between August 2017 and September 2019 we enrolled consecutive adult patients with SAB in a prospective cohort study in seven hospitals in the Netherlands. Using the modified Duke Criteria for definite endocarditis as reference standard, sensitivity, specificity, negative predictive (NPV) and positive predictive values (PPV) were determined for the POSITIVE, PREDICT and VIRSTA scores. A NPV of at least 98% was considered safe for excluding endocarditis.

RESULTS: Of 477 SAB patients enrolled, 33% had community-acquired SAB, 8% had a prosthetic valve and 11% a cardiac implantable electronic device. Echocardiography was performed in 87% of patients, and 42% received a TEE. 87 (18.2%) had definite endocarditis. Sensitivity was 77.6% (65.8 - 86.9), 85.1% (75.8 - 91.8) and 98.9% (95.7 - 100) for the POSITIVE (n=362), PREDICT and VIRSTA scores, respectively. NPVs were 92.5% (87.9 - 95.8), 94.5% (90.7 - 97.0), and 99.3% (94.9 - 100).) For the POSITIVE, PREDICT and VIRSTA scores, 44.5%, 50.7% and 70.9% of SAB patients, respectively were classified as high-risk for endocarditis.

CONCLUSIONS: Only the VIRSTA score had a NPV of at least 98%, but at the expense of a high number of patients classified as high risk and thus requiring TEE.

PMID:34272564 | DOI:10.1093/cid/ciab632

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