Improving the DENOVA score with the time to blood culture positivity in community acquired Enterococcus faecalis bacteremia

Abstract

INTRODUCTION: DENOVA index has been developed to stratify the risk of infective endocarditis (IE) in patients with Enterococcus faecalis bacteremia. Recently, time to positive (TTP) of blood cultures of E. faecalis has also be related with a higher risk of IE. The objective of the study was to evaluate DENOVA scale with TTP to improve de specificity of the score. MATERIAL AND METHOD: Retrospective, case-control study in adult patients with E. faecalis bacteremia. Patients with definite enterococcal IE were classified as cases. Patients with enterococcal bacteremia and after exclusion of IE were included as control. The probability that DENOVA ± TDP correctly diagnoses patients with IE was estimated using ROC curves. RESULTS: A total of 39 patients with definite E. faecalis IE and 82 patients with E. faecalis bacteremia were included. Nosocomial-acquired bacteremia was observed in 43% of patients. The best value of AUC was obtained by the DENOVA scale without TTP, (AUC = 0.896). In the community bacteremia subgroup, the addition of a TTP ≤ 8 hours to the DENOVA scale improved the accuracy in the prediction of IE (AUC = 0.914). A shorter TTP was not related with a worse prognosis in patients with E. faecalis bacteremia. The only factor related with poor clinical outcome was a Charlson index ≥ 3 (OR 3.4, 95% CI [1.21–9.62], p = 0.020). CONCLUSIONS: In patients with E. faecalis community-acquired bacteremia, the TTP ≤ 8 hours associated with the DENOVA score could improve the prediction of this index in the detection of patients with IE.