Of the 3 predictors studied for the risk of infective endocarditis in patients with a S. aureobacteremia (SAB), the VIRSTA score had the highest negative predictive value, at the expense of a large number of patients classified as ‘high risk’ and therefore requiring transesophageal echocardiography.
The researchers compared the accuracy of the Prediction Of Staphylococcus aureus Infective Endocarditis Time to positivity, intravenous drug use, vascular phenomena, pre-existing cardiac conditions (POSITIVE), Predicting Risk of Endocarditis Using a Clinical Tool (PREDICT) and VIRSTA scores for endocarditis risk classification in patients with SAB.
Between August 2017 and September 2019, consecutive adult patients with SAB were included in a prospective cohort study in 7 Dutch hospitals. Using the modified Duke criteria as the reference standard, sensitivity, specificity, negative predictive value (NPV) and positive predictive value for POSITIVE, PREDICT and VIRSTA scores were determined. An NPV of at least 98% was considered safe to rule out endocarditis.
Of the 477 patients with SAB who participated, 33% had community-acquired SAB, 8% had a heart valve prosthesis, and 11% had ICD. Echocardiography was performed in 87% of patients and 42% underwent transesophageal echocardiography. Eighty-seven patients (18.2%) had definitive endocarditis. Sensitivity was 77.6% (65.8-86.9), respectively; 85.1% (75.8-91.8% and 98.9% (95.7-100) for POSITIVE, PREDICT and VIRSTA scores. NPVs were 92.5% (87.9-95.8) ; 94.5% (90.7-97.0) and 99.3% (94.9-100%). POSITIVE, PREDICT and VIRSTA scores, respectively, measured 44.5%; 50.7% and 70.9% of patients with SAB classified as high risk for endocarditis.
