Emilio Bouza1, Martha Kestler2, Teresa Beca3, Gabriel Mariscal3, Marta Rodríguez-Créixems3, Javier Bermejo4, Ana Fernández-Cruz3, Francisco Fernández-Avilés4, Patricia Muñoz1. 1. Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón Centros de Investigación Biomédica en Red Enfermedades Respiratorias Medicine Department, School of Medicine, Universidad Complutense de Madrid Instituto de Investigación Sanitaria Gregorio Marañón. 2. Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón Medicine Department, School of Medicine, Universidad Complutense de Madrid Instituto de Investigación Sanitaria Gregorio Marañón. 3. Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón. 4. Medicine Department, School of Medicine, Universidad Complutense de Madrid Instituto de Investigación Sanitaria Gregorio Marañón Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Abstract
BACKGROUND: Frequency of enterococcal bloodstream infection (E-BSI) is increasing, and the number of episodes complicated by infective endocarditis (IE) varies. Performing transesophageal echocardiography (TEE) in all patients with E-BSI is costly and time-consuming. Our objectives were to identify patients with E-BSI who are at very low risk of enterococcal IE (and therefore do not require TEE) and to compare the outcome of E-BSI in patients with/without IE. METHODS: Between September 2003 and October 2012, we performed a prospective cohort study (all patients with E-BSI) and a case-control study (patients with/without enterococcal IE) in our center. RESULTS: We detected 1515 patients with E-BSI and 65 with enterococcal IE (4.29% of all episodes of E-BSI, 16.7% of patients with E-BSI who underwent transthoracic echocardiography, and 35.5% of all patients with E-BSI who underwent TEE). We developed a bedside predictive score for enterococcal IE-Number of positive blood cultures, Origin of the bacteremia, previous Valve disease, Auscultation of heart murmur (NOVA) score-based on the following variables: Number of positive blood cultures (3/3 blood cultures or the majority if more than 3), 5 points; unknown Origin of bacteremia, 4 points; prior heart Valve disease, 2 points; Auscultation of a heart murmur, 1 point (receiver operating characteristic = 0.83). The best cutoff corresponded to a score ≥4 (sensitivity, 100%; specificity, 29%). A score <4 points suggested a very low risk for enterococcal IE and that TEE could be obviated. CONCLUSIONS: Enterococcal IE may be more frequent than generally thought. Depending on local prevalence of endocarditis, application of the NOVA score may safely obviate echocardiography in 14%-27% of patients with E-BSI.
BACKGROUND: Frequency of enterococcal bloodstream infection (E-BSI) is increasing, and the number of episodes complicated by infective endocarditis (IE) varies. Performing transesophageal echocardiography (TEE) in all patients with E-BSI is costly and time-consuming. Our objectives were to identify patients with E-BSI who are at very low risk of enterococcal IE (and therefore do not require TEE) and to compare the outcome of E-BSI in patients with/without IE. METHODS: Between September 2003 and October 2012, we performed a prospective cohort study (all patients with E-BSI) and a case-control study (patients with/without enterococcal IE) in our center. RESULTS: We detected 1515 patients with E-BSI and 65 with enterococcal IE (4.29% of all episodes of E-BSI, 16.7% of patients with E-BSI who underwent transthoracic echocardiography, and 35.5% of all patients with E-BSI who underwent TEE). We developed a bedside predictive score for enterococcal IE-Number of positive blood cultures, Origin of the bacteremia, previous Valve disease, Auscultation of heart murmur (NOVA) score-based on the following variables: Number of positive blood cultures (3/3 blood cultures or the majority if more than 3), 5 points; unknown Origin of bacteremia, 4 points; prior heart Valve disease, 2 points; Auscultation of a heart murmur, 1 point (receiver operating characteristic = 0.83). The best cutoff corresponded to a score ≥4 (sensitivity, 100%; specificity, 29%). A score <4 points suggested a very low risk for enterococcal IE and that TEE could be obviated. CONCLUSIONS: Enterococcal IE may be more frequent than generally thought. Depending on local prevalence of endocarditis, application of the NOVA score may safely obviate echocardiography in 14%-27% of patients with E-BSI.
Authors: Matthew L Faron; Blake W Buchan; Christopher Coon; Theo Liebregts; Anita van Bree; Arjan R Jansz; Genevieve Soucy; John Korver; Nathan A Ledeboer Journal: J Clin Microbiol Date: 2016-07-13 Impact factor: 5.948
Authors: Xinglin Zhang; Vincent de Maat; Ana M Guzmán Prieto; Tomasz K Prajsnar; Jumamurat R Bayjanov; Mark de Been; Malbert R C Rogers; Marc J M Bonten; Stéphane Mesnage; Rob J L Willems; Willem van Schaik Journal: BMC Genomics Date: 2017-11-21 Impact factor: 3.969
Authors: Patricia Muñoz; Martha Kestler; Arístides De Alarcon; José María Miro; Javier Bermejo; Hugo Rodríguez-Abella; Maria Carmen Fariñas; Manuel Cobo Belaustegui; Carlos Mestres; Pedro Llinares; Miguel Goenaga; Enrique Navas; José Antonio Oteo; Paola Tarabini; Emilio Bouza Journal: Medicine (Baltimore) Date: 2015-10 Impact factor: 1.817
Authors: Andreas Berge; Karin Kronberg; Torgny Sunnerhagen; Bo H K Nilson; Christian G Giske; Magnus Rasmussen Journal: Open Forum Infect Dis Date: 2019-10-04 Impact factor: 3.835
Authors: Rachael A Lee; Daniel T Vo; Joanna C Zurko; Russell L Griffin; J Martin Rodriguez; Bernard C Camins Journal: Open Forum Infect Dis Date: 2020-02-19 Impact factor: 3.835