Andreas Berge1,2, Andrea Krantz3, Helena Östlund1, Pontus Nauclér1,2, Magnus Rasmussen4,5. 1. Unit of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden. 2. Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden. 3. Department of Clinical Sciences Lund, Division of Infection Medicine, Lund University, BMC B14, Tornavägen 10, 223 63, Lund, Sweden. 4. Department of Clinical Sciences Lund, Division of Infection Medicine, Lund University, BMC B14, Tornavägen 10, 223 63, Lund, Sweden. magnus.rasmussen@med.lu.se. 5. Division for Infectious Diseases, Skåne University Hospital, Lund, Sweden. magnus.rasmussen@med.lu.se.
Abstract
OBJECTIVES: Enterococcal bacteremia can be complicated by infective endocarditis (IE) and when suspected, transesophageal echocardiography (TEE) should be performed. The previously published NOVA score can identify patients with enterococcal bacteremia at risk for IE and we aimed to improve the score. METHODS: Factors associated with IE were studied retrospectively in a population-based cohort of patients with monomicrobial Enterococcus faecalis bacteremia (MEFsB). Factors associated with IE in multivariable analysis were included in a new score system which was compared to the NOVA score and validated in a cohort of patients with MEFsB from another region. RESULTS: Among 397 episodes of MEFsB, 44 episodes with IE were compared to those without IE. Long Duration of symptoms (≥ 7 days) and Embolization were associated with IE in the multivariate analysis and hence were added to the NOVA variables (Number of positive cultures, Origin of infection unknown, Valve disease, and Auscultation of murmur) to generate a novel score; DENOVA. The area under the curve in ROC analyses was higher for DENOVA (0.95) compared to NOVA (0.91) (p = 0.001). With a cutoff at ≥ 3 positive variables the DENOVA score has a sensitivity of 100% and specificity of 83% which is superior to the NOVA score (specificity 29%). The DENOVA score was applied to the validation cohort (26 IE episodes and 256 non-IE episodes) and the resulting sensitivity was 100% and the specificity was 85% compared to 35% for NOVA. CONCLUSIONS: The DENOVA score is a useful tool to identify patients with MEFsB where TEE is not needed.
OBJECTIVES:Enterococcal bacteremia can be complicated by infective endocarditis (IE) and when suspected, transesophageal echocardiography (TEE) should be performed. The previously published NOVA score can identify patients with enterococcal bacteremia at risk for IE and we aimed to improve the score. METHODS: Factors associated with IE were studied retrospectively in a population-based cohort of patients with monomicrobial Enterococcus faecalisbacteremia (MEFsB). Factors associated with IE in multivariable analysis were included in a new score system which was compared to the NOVA score and validated in a cohort of patients with MEFsB from another region. RESULTS: Among 397 episodes of MEFsB, 44 episodes with IE were compared to those without IE. Long Duration of symptoms (≥ 7 days) and Embolization were associated with IE in the multivariate analysis and hence were added to the NOVA variables (Number of positive cultures, Origin of infection unknown, Valve disease, and Auscultation of murmur) to generate a novel score; DENOVA. The area under the curve in ROC analyses was higher for DENOVA (0.95) compared to NOVA (0.91) (p = 0.001). With a cutoff at ≥ 3 positive variables the DENOVA score has a sensitivity of 100% and specificity of 83% which is superior to the NOVA score (specificity 29%). The DENOVA score was applied to the validation cohort (26 IE episodes and 256 non-IE episodes) and the resulting sensitivity was 100% and the specificity was 85% compared to 35% for NOVA. CONCLUSIONS: The DENOVA score is a useful tool to identify patients with MEFsB where TEE is not needed.
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