Soins bucco-dentaires, antibioprophylaxie et risque d’endocardite infectieuse chez les patients porteurs de prothèses valvulaires

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

“…Previously validated scores in SAB cases include VIRSTA, which utilizes IE predictors such as cerebral or extra-cerebral emboli, vertebral osteomyelitis, and persistent bacteremia [18]. However, waiting to establish persistent SAB can ultimately delay securing an IE diagnosis.…”

“…Thus, the development of an individualized risk-based approach to guide utilization of TEE in patients with SAB is warranted [16]. In this regard, several predictors of IE in SAB have already been identified [17][18][19][20][21]. Our group previously published a novel scoring system, "PREDICT" (Predicting Risk of Endocarditis Using a Clinical Tool) that included an individualized risk-scoring system to identify patients with SAB who are more likely to harbor IE and would benefit from TEE (Table 1) [17].…”

A Scenario-Based Survey of Expert Echocardiography Recommendations for Patients With Staphylococcus aureus Bacteremia at Varying Risk for Endocarditis

“…We developed an anonymous web-based multiple-choice survey (eResults in the Supplement) to assess the echocardiography recommendations of expert clinicians for a set of 50 text-based SAB scenarios based on the VIRSTA score. 8 Scenarios were generated by varying patient age, the risk factors for endocarditis contained in the VIRSTA score, and the presence of an extracardiac focus of infection requiring prolonged treatment (either a prosthetic joint infection or vertebral osteomyelitis) to generate clinically plausible text-based descriptions of a SAB episode (eFigure 1 in the Supplement). Respondents were not informed that the scenarios were based on an endocarditis prediction score, nor that the scenarios were constructed specifically to vary their risk of endocarditis.…”

“…The scenarios presented to respondents are clearly simplifications of a complex disease process. Although we included endocarditis risk factors identified in the analysis of the largest relevant published data set, 8 there may be other important pieces of clinical information respondents may use to guide their echocardiography decision-making. This may include whether a patient would be fit for cardiac surgery, a complex consideration that was not captured in our scenarios other than through the variables describing patient age and health care-associated acquisition of bacteremia.…”

“…Most of these have focused on patients at low risk of endocarditis, 7 but some capture a range of risks, such as the VIRSTA score. 8 This scoring system was derived from a multicenter French cohort study including more than 2000 episodes of SAB and used modified Duke criteria consensus adjudication at 12 weeks as the reference standard. Ten clinical and microbiological factors were independently associated with a diagnosis of endocarditis: C-reactive protein level greater than19 mg/dL (to convert to milligrams per liter, multiply by 10), severe sepsis, nonnosocomial acquisition, vertebral osteomyelitis, persistent bacteremia beyond 48 hours, intravenous drug use, preexisting native valve disease, permanent intracardiac device or previous endocarditis, meningitis, and cerebral or peripheral emboli.…”