External validation of the HANDOC score – high sensitivity to identify patients with non-beta-haemolytic streptococcal endocarditis

Sunnerhagen, Torgny; Andersen, Malene Højgaard; Bruun, Niels Eske; Bundgaard, Henning; Iversen, Kasper; Rasmussen, Magnus

doi:10.1080/23744235.2019.1679388

“…The results of this study were in line with the ndings in several studies (9,21,25), showing that the risk of IE was diverse between groups of NBHS. S. sanguinis, S. bovis, and S. mutans are prone to cause IE, S. mitis and S. salivarius are connected to an intermediate risk, and S anginosus is unlikely to cause IE.…”

Section: Discussionsupporting

confidence: 92%

“…Species designations were used according to the 2022 International Code of Nomenclature of Prokaryotes (ICPN) and the List of Prokaryotic names with Standing in Nomenclature (LPSN) (19,20). The grouping of streptococcal species into the S. mitis group, S. anginosus group, S. sanguinis group, S. salivarius group, S. mutans group, and S. bovis group was done in concordance with previous publications (9,(21)(22)(23).…”

Section: Microbiologymentioning

confidence: 99%

Non-betahemolytic streptococcal bacteremia, cardiac implantable electronic device, endocarditis, extraction, and outcome; a population- based retrospective cohort study

Berge,

Lundin,

Bläckberg

et al. 2023

Preprint

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Purpose Patients with non-beta-hemolytic streptococcal bacteremia (NBHSB) are at risk of infective endocarditis (IE). Patients with cardiac implantable electronic device (CIED) have been described to have an increased risk of IE. The aim of the study was to describe a population-based cohort of patients with NBHSB and CIED and variables associated with IE and recurrent NBHSB. Methods All episodes with NBHSB in blood culture from 2015 to 2018 in a population of 1.3 million inhabitants were collected from the Clinical Microbiology Laboratory, Lund, Sweden. Through medical records, patients with CIED during NBHSB were identified and clinical data were collected. Patients were followed 365 days after NBHSB. Results Eighty-five episodes in 79 patients with CIED and NBHSB constituted the cohort. Eight patients (10%) were diagnosed with definite IE during the first episode, five of whom also had heart valve prosthesis (HVP). In 39 patients (49%) transesophageal echocardiography (TEE) was performed of which six indicated IE. Four patients had the CIED extracted. Twenty-four patients did not survive (30%) the study period. Four patients had a recurrent infection with NBHSB with the same species, three of whom had HVP and had been evaluated with TEE with a negative result during the first episode and diagnosed with IE during the recurrency. Conclusion The study did not find a high risk of IE in patients with NBHSB and CIED. Most cases of IE were in conjunction with a simultaneous HVP. A management algorithm is suggested.

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“…The score is aimed to guide the use of echocardiography by evaluating six factors: Heart murmur or valvular disease, Aetiology, Number of cultures, Duration of symptoms, Only one species, and Community acquisition. Despite the fact, that the score showed a high sensitivity in an external validation [ 21 ], the study was limited by only including few IE cases, not including all the different streptococcal species and not differentiating between when to perform TTE or TOE. Surprisingly, the authors only found 4 cases of IE in 102 S. mitis group BSIs in sharp contrast to most other studies finding S. mitis to cause the majority of IE cases in streptococcal BSIs [ 9 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Proposal for the use of echocardiography in bloodstream infections due to different streptococcal species

Chamat-Hedemand

¹

,

Bruun

²

,

Østergaard

³

et al. 2021

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Background Infective endocarditis (IE) is diagnosed in 7–8% of streptococcal bloodstream infections (BSIs), yet it is unclear when to perform transthoracic (TTE) and transoesophageal echocardiography (TOE) according to different streptococcal species. The aim of this sub-study was to propose a flowchart for the use of echocardiography in streptococcal BSIs. Methods In a population-based setup, we investigated all patients admitted with streptococcal BSIs and crosslinked data with nationwide registries to identify comorbidities and concomitant hospitalization with IE. Streptococcal species were divided in four groups based on the crude risk of being diagnosed with IE (low-risk < 3%, moderate-risk 3–10%, high-risk 10–30% and very high-risk > 30%). Based on number of positive blood culture (BC) bottles and IE risk factors (prosthetic valve, previous IE, native valve disease, and cardiac device), we further stratified cases according to probability of concomitant IE diagnosis to create a flowchart suggesting TTE plus TOE (IE > 10%), TTE (IE 3–10%), or “wait & see” (IE < 3%). Results We included 6393 cases with streptococcal BSIs (mean age 68.1 years [SD 16.2], 52.8% men). BSIs with low-risk streptococci (S. pneumoniae, S. pyogenes, S. intermedius) are not initially recommended echocardiography, unless they have ≥3 positive BC bottles and an IE risk factor. Moderate-risk streptococci (S. agalactiae, S. anginosus, S. constellatus, S. dysgalactiae, S. salivarius, S. thermophilus) are guided to “wait & see” strategy if they neither have a risk factor nor ≥3 positive BC bottles, while a TTE is recommended if they have either ≥3 positive BC bottles or a risk factor. Further, a TTE and TOE are recommended if they present with both. High-risk streptococci (S. mitis/oralis, S. parasanguinis, G. adiacens) are directed to a TTE if they neither have a risk factor nor ≥3 positive BC bottles, but to TTE and TOE if they have either ≥3 positive BC bottles or a risk factor. Very high-risk streptococci (S. gordonii, S. gallolyticus, S. mutans, S. sanguinis) are guided directly to TTE and TOE due to a high baseline IE prevalence. Conclusion In addition to the clinical picture, this flowchart based on streptococcal species, number of positive blood culture bottles, and risk factors, can help guide the use of echocardiography in streptococcal bloodstream infections. Since echocardiography results are not available the findings should be confirmed prospectively with the use of systematic echocardiography.

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Non-betahemolytic streptococcal bacteremia, cardiac implantable electronic device, endocarditis, extraction, and outcome; a population-based retrospective cohort study

Berge,

Lundin,

Bläckberg

et al. 2024

Infection

0

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Purpose Patients with non-beta-hemolytic streptococcal bacteremia (NBHSB) are at risk of infective endocarditis (IE). Patients with cardiac implantable electronic device (CIED) have been described to have an increased risk of IE. The aim of the study was to describe a population-based cohort of patients with NBHSB and CIED and variables associated with IE and recurrent NBHSB. Methods All episodes with NBHSB in blood culture from 2015 to 2018 in a population of 1.3 million inhabitants were collected from the Clinical Microbiology Laboratory, Lund, Sweden. Through medical records, patients with CIED during NBHSB were identified and clinical data were collected. Patients were followed 365 days after NBHSB. Results Eighty-five episodes in 79 patients with CIED and NBHSB constituted the cohort. Eight patients (10%) were diagnosed with definite IE during the first episode, five of whom also had heart valve prosthesis (HVP). In 39 patients (49%) transesophageal echocardiography (TEE) was performed of which six indicated IE. Four patients had the CIED extracted. Twenty-four patients did not survive (30%) the study period. Four patients had a recurrent infection with NBHSB with the same species, three of whom had HVP and had been evaluated with TEE with a negative result during the first episode and diagnosed with IE during the recurrency. Conclusion The study did not find a high risk of IE in patients with NBHSB and CIED. Most cases of IE were in conjunction with a simultaneous HVP. A management algorithm is suggested.

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External validation of the HANDOC score – high sensitivity to identify patients with non-beta-haemolytic streptococcal endocarditis

Cited by 8 publications

References 11 publications

Non-betahemolytic streptococcal bacteremia, cardiac implantable electronic device, endocarditis, extraction, and outcome; a population- based retrospective cohort study

Non-betahemolytic streptococcal bacteremia, cardiac implantable electronic device, endocarditis, extraction, and outcome; a population- based retrospective cohort study

Proposal for the use of echocardiography in bloodstream infections due to different streptococcal species

Non-betahemolytic streptococcal bacteremia, cardiac implantable electronic device, endocarditis, extraction, and outcome; a population-based retrospective cohort study

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