Juan Sebastián Peinado-Acevedo1,2, Juan José Hurtado-Guerra2,3, Carolina Hincapié2,4, Juanita Mesa-Abad2, José Roberto Uribe-Delgado2, Santiago Giraldo-Ramírez5, Paula A Lengerke-Diaz6, Fabián Jaimes2,3,7. 1. Departamento de Medicina Interna, Hospital Pablo Tobón Uribe y Sura, Medellín, Colombia. 2. Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia. 3. Departamento de Medicina Interna, Hospital San Vicente Fundación, Medellín, Colombia. 4. Grupo Académico de Epidemiología Clínica (GRAEPIC), Universidad de Antioquia, Medellín, Colombia. 5. Departamento de Cardiología, Hospital Universitario San Vicente Fundación, Medellín, Colombia. 6. Department of Internal Medicine. Division of Hematology and Clinical Oncology, Mayo Clinic, Scottsdale, Arizona, USA. 7. Dirección de Investigaciones, Hospital San Vicente Fundación, Medellín, Colombia.
Abstract
BACKGROUND: Infective endocarditis (IE) secondary to Staphylococcus aureus bacteremia (SAB) has high morbidity and mortality. The systematic use of echocardiography in SAB is controversial. We aimed to validate VIRSTA and Predicting Risk of Endocarditis Using a Clinical Tool (PREDICT) scores for predicting the risk of IE in Colombian patients with SAB and, consequently, to determine the need for echocardiography. METHODS: Cohort of patients hospitalized with SAB in 2 high complexity institutions in Medellin, Colombia, between 2012 and 2018. The diagnosis of IE was established based on the modified Duke criteria. The VIRSTA and PREDICT scores were calculated from the clinical records, and their operational performance was calculated. RESULTS: The final analysis included 922 patients, 62 (6.7%) of whom were diagnosed with IE. The frequency of IE in patients with a negative VIRSTA scale was 0.44% (2/454). The frequency of IE in patients with a negative PREDICT scale on day 5 was 4.8% (30/622). The sensitivity and negative predictive value (NPV) of the VIRSTA scale was 96.7% and 99.5%, respectively. For the PREDICT scale on day 5, the sensitivity and NPV were 51.6% and 95.1%, respectively. The discrimination, given by the area under the receiver operating characteristic curve, was 0.86 for VIRSTA and 0.64 for PREDICT. CONCLUSIONS: In patients with negative VIRSTA, screening echocardiography may be unnecessary because of the low frequency of IE. In PREDICT-negative patients, despite the low frequency of IE, it is not safe to omit echocardiography.
BACKGROUND: Infective endocarditis (IE) secondary to Staphylococcus aureus bacteremia (SAB) has high morbidity and mortality. The systematic use of echocardiography in SAB is controversial. We aimed to validate VIRSTA and Predicting Risk of Endocarditis Using a Clinical Tool (PREDICT) scores for predicting the risk of IE in Colombian patients with SAB and, consequently, to determine the need for echocardiography. METHODS: Cohort of patients hospitalized with SAB in 2 high complexity institutions in Medellin, Colombia, between 2012 and 2018. The diagnosis of IE was established based on the modified Duke criteria. The VIRSTA and PREDICT scores were calculated from the clinical records, and their operational performance was calculated. RESULTS: The final analysis included 922 patients, 62 (6.7%) of whom were diagnosed with IE. The frequency of IE in patients with a negative VIRSTA scale was 0.44% (2/454). The frequency of IE in patients with a negative PREDICT scale on day 5 was 4.8% (30/622). The sensitivity and negative predictive value (NPV) of the VIRSTA scale was 96.7% and 99.5%, respectively. For the PREDICT scale on day 5, the sensitivity and NPV were 51.6% and 95.1%, respectively. The discrimination, given by the area under the receiver operating characteristic curve, was 0.86 for VIRSTA and 0.64 for PREDICT. CONCLUSIONS: In patients with negative VIRSTA, screening echocardiography may be unnecessary because of the low frequency of IE. In PREDICT-negative patients, despite the low frequency of IE, it is not safe to omit echocardiography.
Authors: Thomas W van der Vaart; Jan M Prins; Robin Soetekouw; Gitte van Twillert; Jan Veenstra; Bjorn L Herpers; Wouter Rozemeijer; Rogier R Jansen; Marc J M Bonten; Jan T M van der Meer Journal: Clin Infect Dis Date: 2022-04-28 Impact factor: 20.999
Authors: Jorge Calderón-Parra; Itziar Diego-Yagüe; Beatriz Santamarina-Alcantud; Susana Mingo-Santos; Alberto Mora-Vargas; José Manuel Vázquez-Comendador; Ana Fernández-Cruz; Elena Muñez-Rubio; Andrea Gutiérrez-Villanueva; Isabel Sánchez-Romero; Antonio Ramos-Martínez Journal: J Clin Med Date: 2022-03-09 Impact factor: 4.241