Omar Abu Saleh1, Madiha Fida1, Kara Asbury2, Aalap Narichania3, David Sotello4, Wendelyn Bosch4, Holenarasipur R Vikram2, Raj Palraj1, Brian Lahr5, Larry M Baddour1,6, M Rizwan Sohail1,6. 1. Division of Infectious Diseases, Department of Medicine, Mayo Clinic Rochester, Minnesota. 2. Division of Infectious Diseases, Mayo Clinic Phoenix, Arizona. 3. Department of Medicine, Mayo Clinic Phoenix, Arizona. 4. Division of Infectious Diseases, Mayo Clinic Jacksonville, Florida. 5. Department of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota. 6. Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Abstract
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.
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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