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The VIRSTA score, a prediction score to estimate risk of infective endocarditis and determine priority for echocardiography in patients with Staphylococcus aureus bacteremia

2016; Elsevier BV; Volume: 72; Issue: 5 Linguagem: Inglês

10.1016/j.jinf.2016.02.003

1532-2742

Sarah Tubiana, Xavier Duval, François Alla, Christine Selton‐Suty, Pierre Tattevin, François Delahaye, Lionel Piroth, Catherine Chirouze, Jean‐Philippe Lavigne, Marie‐Line Erpelding, Bruno Hoen, François Vandenesch, Bernard Iung, Vincent Le Moing,

Streptococcal Infections and Treatments

Summary Objectives To develop and validate a prediction score, to quantify, within 48 h of Staphylococcus aureus bacteremia (SAB) diagnosis, the risk of IE, and therefore determine priority for urgent echocardiography. Methods Consecutive adult patients with SAB in 8 French university hospitals between 2009 and 2011 were prospectively enrolled and followed-up 3 months. A predictive model was developed and internally validated using bootstrap procedures. Results Among the 2008 patients enrolled, 221 (11.0%) had definite IE of whom 39 (17.6%) underwent valve surgery, 25% of them within 6 days of SAB diagnosis. Ten predictors independently associated with IE were used to build up the prediction score: intracardiac device or previous IE, native valve disease, intravenous drug use, community or non-nosocomial-acquisition, cerebral or extracerebral emboli, vertebral osteomyelitis, severe sepsis, meningitis, C-reactive protein above 190 mg/L, and H48-persistent bacteremia. Patients with a score ≤2 (n = 792, 39.4%) were at low IE-risk (1.1%; negative predictive value: 98.8% (95% CI, 98.4–99.4)) compared to those ≥3 who were at higher risk (17.4%). Conclusions Physicians must be strongly encouraged to urgently perform echocardiography in SAB patients with a score ≥3 to establish IE diagnosis, to orient antimicrobial therapy and to help determine the need for valvular surgery.