Unreliability of Clinical Prediction Rules to Exclude without Echocardiography Infective Endocarditis in <i>Staphylococcus</i> <i>aureus</i> Bacteremia
Background: It is unclear whether the use of clinical prediction rules is sufficient to rule out infective endocarditis (IE) in patients with <i>Staphylococcus</i> <i>aureus</i> bacteremia (SAB) without an echocardiogram evaluation, either transthoracic (TTE) and/or transesop...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-03-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/6/1502 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Jorge Calderón-Parra |
| collection | DOAJ |
| description | Background: It is unclear whether the use of clinical prediction rules is sufficient to rule out infective endocarditis (IE) in patients with <i>Staphylococcus</i> <i>aureus</i> bacteremia (SAB) without an echocardiogram evaluation, either transthoracic (TTE) and/or transesophageal (TEE). Our primary purpose was to test the usefulness of PREDICT, POSITIVE, and VIRSTA scores to rule out IE without echocardiography. Our secondary purpose was to evaluate whether not performing an echocardiogram evaluation is associated with higher mortality. Methods: We conducted a unicentric retrospective cohort including all patients with a first SAB episode from January 2015 to December 2020. IE was defined according to modified Duke criteria. We predefined threshold cutoff points to consider that IE was ruled out by means of the mentioned scores. To assess 30-day mortality, we used a multivariable regression model considering performing an echocardiogram as covariate. Results: Out of 404 patients, IE was diagnosed in 50 (12.4%). Prevalence of IE within patients with negative PREDICT, POSITIVE, and VIRSTA scores was: 3.6% (95% CI 0.1–6.9%), 4.9% (95% CI 2.2–7.7%), and 2.2% (95% CI 0.2–4.3%), respectively. Patients with negative VIRSTA and negative TTE had an IE prevalence of 0.9% (95% CI 0–2.8%). Performing an echocardiogram was independently associated with lower 30-day mortality (OR 0.24 95% CI 0.10–0.54, <i>p</i> = 0.001). Conclusion: PREDICT and POSITIVE scores were not sufficient to rule out IE without TEE. In patients with negative VIRSTA score, it was doubtful if IE could be discarded with a negative TTE. Not performing an echocardiogram was associated with worse outcomes, which might be related to presence of occult IE. Further studies are needed to assess the usefulness of clinical prediction rules in avoiding echocardiographic evaluation in SAB patients. |
| first_indexed | 2024-03-09T19:38:12Z |
| format | Article |
| id | doaj.art-522a91a3aad445f9878665b7356e0496 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T19:38:12Z |
| publishDate | 2022-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-522a91a3aad445f9878665b7356e04962023-11-24T01:47:02ZengMDPI AGJournal of Clinical Medicine2077-03832022-03-01116150210.3390/jcm11061502Unreliability of Clinical Prediction Rules to Exclude without Echocardiography Infective Endocarditis in <i>Staphylococcus</i> <i>aureus</i> BacteremiaJorge Calderón-Parra0Itziar Diego-Yagüe1Beatriz Santamarina-Alcantud2Susana Mingo-Santos3Alberto Mora-Vargas4José Manuel Vázquez-Comendador5Ana Fernández-Cruz6Elena Muñez-Rubio7Andrea Gutiérrez-Villanueva8Isabel Sánchez-Romero9Antonio Ramos-Martínez10Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, SpainInfectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, SpainMicrobiology Service, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, SpainCardiology Department, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, SpainInfectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, SpainInfectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, SpainInfectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, SpainInfectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, SpainInfectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, SpainMicrobiology Service, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, SpainInfectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, SpainBackground: It is unclear whether the use of clinical prediction rules is sufficient to rule out infective endocarditis (IE) in patients with <i>Staphylococcus</i> <i>aureus</i> bacteremia (SAB) without an echocardiogram evaluation, either transthoracic (TTE) and/or transesophageal (TEE). Our primary purpose was to test the usefulness of PREDICT, POSITIVE, and VIRSTA scores to rule out IE without echocardiography. Our secondary purpose was to evaluate whether not performing an echocardiogram evaluation is associated with higher mortality. Methods: We conducted a unicentric retrospective cohort including all patients with a first SAB episode from January 2015 to December 2020. IE was defined according to modified Duke criteria. We predefined threshold cutoff points to consider that IE was ruled out by means of the mentioned scores. To assess 30-day mortality, we used a multivariable regression model considering performing an echocardiogram as covariate. Results: Out of 404 patients, IE was diagnosed in 50 (12.4%). Prevalence of IE within patients with negative PREDICT, POSITIVE, and VIRSTA scores was: 3.6% (95% CI 0.1–6.9%), 4.9% (95% CI 2.2–7.7%), and 2.2% (95% CI 0.2–4.3%), respectively. Patients with negative VIRSTA and negative TTE had an IE prevalence of 0.9% (95% CI 0–2.8%). Performing an echocardiogram was independently associated with lower 30-day mortality (OR 0.24 95% CI 0.10–0.54, <i>p</i> = 0.001). Conclusion: PREDICT and POSITIVE scores were not sufficient to rule out IE without TEE. In patients with negative VIRSTA score, it was doubtful if IE could be discarded with a negative TTE. Not performing an echocardiogram was associated with worse outcomes, which might be related to presence of occult IE. Further studies are needed to assess the usefulness of clinical prediction rules in avoiding echocardiographic evaluation in SAB patients.https://www.mdpi.com/2077-0383/11/6/1502<i>Staphylococcus</i> <i>aureus</i>endocarditisclinical prediction rulesechocardiography |
| spellingShingle | 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 Unreliability of Clinical Prediction Rules to Exclude without Echocardiography Infective Endocarditis in <i>Staphylococcus</i> <i>aureus</i> Bacteremia Journal of Clinical Medicine <i>Staphylococcus</i> <i>aureus</i> endocarditis clinical prediction rules echocardiography |
| title | Unreliability of Clinical Prediction Rules to Exclude without Echocardiography Infective Endocarditis in <i>Staphylococcus</i> <i>aureus</i> Bacteremia |
| title_full | Unreliability of Clinical Prediction Rules to Exclude without Echocardiography Infective Endocarditis in <i>Staphylococcus</i> <i>aureus</i> Bacteremia |
| title_fullStr | Unreliability of Clinical Prediction Rules to Exclude without Echocardiography Infective Endocarditis in <i>Staphylococcus</i> <i>aureus</i> Bacteremia |
| title_full_unstemmed | Unreliability of Clinical Prediction Rules to Exclude without Echocardiography Infective Endocarditis in <i>Staphylococcus</i> <i>aureus</i> Bacteremia |
| title_short | Unreliability of Clinical Prediction Rules to Exclude without Echocardiography Infective Endocarditis in <i>Staphylococcus</i> <i>aureus</i> Bacteremia |
| title_sort | unreliability of clinical prediction rules to exclude without echocardiography infective endocarditis in i staphylococcus i i aureus i bacteremia |
| topic | <i>Staphylococcus</i> <i>aureus</i> endocarditis clinical prediction rules echocardiography |
| url | https://www.mdpi.com/2077-0383/11/6/1502 |
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