Sarah Tubiana1, Xavier Duval2, François Alla3, Christine Selton-Suty4, Pierre Tattevin5, François Delahaye6, Lionel Piroth7, Catherine Chirouze8, Jean-Philippe Lavigne9, Marie-Line Erpelding10, Bruno Hoen11, François Vandenesch12, Bernard Iung13, Vincent Le Moing14. 1. IAME, Inserm UMR 1137, Univ. Paris Diderot, Sorbonne Paris Cité, Paris, France; Inserm Clinical Investigation Center 1425, Paris, France. 2. IAME, Inserm UMR 1137, Univ. Paris Diderot, Sorbonne Paris Cité, Paris, France; Inserm Clinical Investigation Center 1425, Paris, France. Electronic address: xavier.duval@bch.aphp.fr. 3. Université de Lorraine, Université Paris Descartes, Apemac, EA 4360, France; Inserm, CIC-EC, CIE6, Nancy, F-54000, France; CHU Nancy, Pôle S2R, Épidémiologie et Évaluation Cliniques, Nancy, F-54000, France. 4. Centre Hospitalier Universitaire de Nancy, Nancy, France. 5. Hôpital Pontchaillou, Inserm U835, Faculté de Médecine, Université Rennes 1, IFR140, Rennes, France. 6. Hospices Civils de Lyon, Université Claude Bernard, Lyon, France. 7. CHU de Dijon, UMR 1347-MERS, Université de Bourgogne, Dijon, France. 8. UMR CNRS 6249 Chrono-environnement, Université de Franche-Comté, CHU de Besançon, Besançon, France. 9. CHU Carémeau, INSERM U1047, Université Montpellier 1, Nîmes, France. 10. Inserm, CIC-EC, CIE6, Nancy, F-54000, France; Centre Hospitalier Universitaire de Nancy, Nancy, France. 11. Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, EA 4537, France; Centre Hospitalier Universitaire de Pointe-à-Pitre, Inserm CIC1424, Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne, Pointe-à-Pitre, France. 12. Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Centre International de Recherche en Infectiologie, INSERM U1111, Université Lyon 1, CNRS, UMR 5308, Lyon, France. 13. Cardiology Department, AP-HP, Bichat Hospital Paris, France; DHU Fire, Paris, France. 14. CHU de Montpellier, UMI 233 Université Montpellier 1, Institut de Recherche pour le Développement, Montpellier, France.
Abstract
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.
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 SABpatients with a score ≥3 to establish IE diagnosis, to orient antimicrobial therapy and to help determine the need for valvular surgery.
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