Risk assessment for infected endocarditis in <i>Staphylococcus aureus</i> bacteremia patients: When is transesophageal echocardiography needed?

Longobardo, Luca; Klemm, Sarah; Cook, Margaret; Ravenna, Valerie; Brummitt, Charles F; Mengesha, Tadele; Khandheria, Bijoy K.

doi:10.1177/2048872617735809

Cited by 8 publications

(10 citation statements)

References 24 publications

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“…The prevalence of IE in patients with low risk is very low, between 0% and 5%. [8][9][10][11][12][13][14][15][16][17][18][19][20] These results are similar to those of the present study that identified 2 IE patients among the study population. Interestingly, both patients were diagnosed with right-sided IE.…”

Section: Discussionsupporting

confidence: 90%

“…Most previous studies evaluating the benefits of echocardiography in SAB included substantial groups of patients who did not undergo echocardiography (range: 13-79%). [8][9][10][11][13][14][15][16][17][18][19][20] Such patients were excluded [8,14,19,20] or assessed by occurrence of SAB or IE during varying follow-up durations. [9][10][11][12][13][15][16][17][18] However, these studies included heterogeneous sources of bacteremia, and the duration of treatment was either prolonged or was not considered, factors that could conceal undetected IE and obscure the benefits of echocardiography in patients with SAB.…”

Section: Discussionmentioning

confidence: 99%

“…[6,7] Furthermore, many studies have attempted to identify groups at low risk of IE among patients with SAB and evaluated the necessity of echocardiography, especially transesophageal echocardiography (TEE). [8][9][10][11][12][13][14][15][16][17][18][19][20] These studies have identified factors associated with IE and suggested that patients at low risk of IE may need not TEE or even transthoracic echocardiography (TTE).…”

Section: Introductionmentioning

confidence: 99%

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Role of echocardiography in uncomplicated Staphylococcus aureus catheter-related bloodstream infections

et al. 2021

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Uncomplicated bacteremia and catheter-related bloodstream infection (CRBSI) are frequently suggested as factors associated with low risk of infective endocarditis in Staphylococcus aureus bacteremia (SAB). Nevertheless, guidelines recommend that echocardiography in all patients with SAB. We evaluated the effects of echocardiography on patient outcomes. Patients with uncomplicated S. aureus CRBSI were retrospectively identified between January 2013 and June 2018 at a 1950-bed, tertiary-care university hospital. Treatment failure was defined as any case of relapse or all-cause death within 90 days. Of 890 SAB patients, 95 with uncomplicated S. aureus CRBSI were included. Thirty-two patients underwent echocardiography within 30 days of their first positive blood culture. Two patients who underwent echocardiography revealed right-sided infective endocarditis. One patient who did not undergo echocardiography experienced recurrent SAB (peripheral CRBSI) 85 days after his first positive blood culture. There were no SAB-related deaths. The Kaplan–Meier curves of treatment failure showed no significant differences between patients who did and did not undergo echocardiography ( P = .77). In multivariable analysis, risk factors for treatment failure were liver cirrhosis (hazard ratio: 9.60; 95% confidence interval: 2.13–43.33; P = .003) and other prostheses (hazard ratio: 63.79; 95% confidence interval: 5.05–805.40; P = .001). This study did not verify the putative association between treatment failure and implementation of echocardiography in patients with uncomplicated S. aureus CRBSI. Given the low observed rates of adverse outcomes, routine echocardiography might not be obligatory and could be performed on an individual basis.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Role of echocardiography in uncomplicated Staphylococcus aureus catheter-related bloodstream infections

et al. 2021

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“…Intravenous drug use (IDU) was not a significant risk factor associated with IE in our cohort, but only 3 patients described this as a potential risk factor. In a retrospective validation study of the PREDICT score in 257 patients with SAB, however, IDU was a risk factor for IE and was added to the PREDICT score, resulting in improved sensitivities of 42.1% and 97% and specificities of 88.6% and 32% at day 1 and day 5 [32].…”

Section: Discussionmentioning

confidence: 99%

Prospective Validation of PREDICT and Its Impact on the Transesophageal Echocardiography Use in Management of Staphylococcus aureus Bacteremia

Saleh

Fida

Asbury

et al. 2020

Clinical Infectious Diseases

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Background Infective endocarditis (IE) is the most feared complication of Staphylococcus aureus bacteremia (SAB). Transesophageal echocardiogram (TEE) is generally recommended for all patients with SAB, however, supporting data for this are limited. We previously developed a scoring system, “PREDICT”, that quantifies the risk of IE and identifies patients who would benefit the most from undergoing TEE. The current prospective investigation aims to validate this score. Methods We prospectively screened all consecutive adults (≥18 years) hospitalized with SAB at three Mayo Clinic sites between January 2015 and March 2017. Results Of 220 patients screened, 199 with SAB met study criteria and were included in the investigation. Of them, 23 (11.6%) patients were diagnosed with definite IE within 12 weeks of initial presentation based on modified Duke’s criteria. Using the previously derived PREDICT model, the day 1 score of ≥4 had a sensitivity of 30.4% and a specificity of 93.8%, whereas day 5 score of ≤2 had a sensitivity and negative predictive value of 100%. Additional factors including surgery or invasive procedure in the past 30 days, prosthetic heart valve, and higher number of positive blood culture bottles in the first set of cultures were associated with increased risk of IE independent of the day 5 risk score. Conclusion We validated the previously developed PREDICT scoring tools for stratifying risk of IE, and the need for undergoing a TEE, among cases of SAB. We also identified other factors with predictive potential, although larger prospective studies are needed to further evaluate possible enhancements to the current scoring system.

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“…A study in patients with Staphylococcus aureus bacteremia assessed the Palraj scoring system used for the detection of patients at high risk for infective endocarditis and as a guide for selective use of TEE. 9 Inclusion of intravenous drug abuse as a variable improved the score’s sensitivity and specificity. The results of this study recommend the use of the modified Palraj scoring system in the diagnostic evaluation of patients with Staphylococcus aureus bacteremia.…”

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confidence: 99%

A triptych on acute cardiovascular care

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2019

European Heart Journal: Acute Cardiovascular Care

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Risk assessment for infected endocarditis in Staphylococcus aureus bacteremia patients: When is transesophageal echocardiography needed?

Abstract: We modify and expand upon an effective scoring system to identify SAB patients at high risk for endocarditis in order to guide use of TEE. The inclusion of IVDA in the criteria for the calculation of the scores improves its effectiveness.

Cited by 8 publications

References 24 publications

Role of echocardiography in uncomplicated Staphylococcus aureus catheter-related bloodstream infections

Role of echocardiography in uncomplicated Staphylococcus aureus catheter-related bloodstream infections

Prospective Validation of PREDICT and Its Impact on the Transesophageal Echocardiography Use in Management of Staphylococcus aureus Bacteremia

A triptych on acute cardiovascular care

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