The VIRSTA score, a prediction score to estimate risk of infective endocarditis and determine priority for echocardiography in patients with Staphylococcus aureus bacteremia

Tubiana, Sarah; Duval, Xavier; Alla, François; Selton-Suty, Christine; Tattevin, Pierre; Delahaye, François; Piroth, Lionel; Chirouze, Catherine; Lavigne, Jean‐Philippe; Erpelding, Marie-Line; Hoën, Bruno; Vandenesch, François; Iung, Bernard; Moing, Vincent Le

doi:10.1016/j.jinf.2016.02.003

Cited by 93 publications

(98 citation statements)

References 28 publications

(49 reference statements)

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“…Absolute benefit of various echocardiography strategies for 90-day survival compared with no echocardiography and treatment with short course therapy ( NE2 ) for a patient with a VIRSTA score [3] of less than 3 points (risk of endocarditis 1.8%; 95% confidence interval, 1.0–3.6%) at a transesophageal echocardiography (TEE)-associated mortality risk of 0.01%. Boxes denote the 25th, 50th, and 75th percentile values, and the whiskers contain the 95% onfidence interval.…”

Section: Resultsmentioning

confidence: 99%

“…We also examined the absolute benefit of each of the strategies above NE2 (as the simplest and least burdensome option) in 2 informative scenarios. The first examined patients with a VIRSTA score [3] of less than 3 points (risk of endocarditis 1.8%, 95% confidence interval 1.0%–3.6%, assuming a prevalence of 18% among unselected patients with SAB [2]) and a TEE-associated mortality of 1.0%. This scenario represents the lowest expected survival benefit of any echocardiography strategy because it is not currently possible to reliably identify patients at any lower risk of endocarditis [4].…”

Section: Methodsmentioning

confidence: 99%

“…Staphylococcus aureus bacteremia (SAB) is complicated by endocarditis in up to 18%–25% of unselected cases [1, 2], although the prevalence of endocarditis among these patients is not uniform and can be estimated using a variety of clinical and microbiological predictors [3]. Several studies have now reported criteria able to identify patients at very low risk (less than 5%) of endocarditis [4].…”

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confidence: 99%

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Benefit of Echocardiography in Patients With Staphylococcus aureus Bacteremia at Low Risk of Endocarditis

Heriot

Tong

Cheng

et al. 2018

Open Forum Infectious Diseases

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BackgroundThe risk of endocarditis among patients with Staphylococcus aureus bacteremia is not uniform, and a number of different scores have been developed to identify patients whose risk is less than 5%. The optimal echocardiography strategy for these patients is uncertain.MethodsWe used decision analysis and Monte Carlo simulation using input parameters taken from the existing literature. The model examined patients with S aureus bacteremia whose risk of endocarditis is less than 5%, generally those with nosocomial or healthcare-acquired bacteremia, no intracardiac prosthetic devices, and a brief duration of bacteremia. We examined 6 echocardiography strategies, including the use of transesophageal echocardiography, transthoracic echocardiography, both modalities, and neither. The outcome of the model was 90-day survival.ResultsThe optimal echocardiography strategy varied with the risk of endocarditis and the procedural mortality associated with transesophageal echocardiography. No echocardiography strategy offered an absolute benefit in 90-day survival of more than 0.5% compared with the strategy of not performing echocardiography and treating with short-course therapy. Strategies using transesophageal echocardiography were never preferred if the mortality of this procedure was greater than 0.5%.ConclusionsIn patients identified to be at low risk of endocarditis, the choice of echocardiography strategy appears to exert a very small influence on 90-day survival. This finding may render test-treatment trials unfeasible and should prompt clinicians to focus on other, more important, management considerations in these patients.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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Benefit of Echocardiography in Patients With Staphylococcus aureus Bacteremia at Low Risk of Endocarditis

Heriot

Tong

Cheng

et al. 2018

Open Forum Infectious Diseases

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“…This diagnostic uncertainty may lead to overdiagnosis of IE in patients with positive results of blood cultures (e.g., non-staphylococcal bacteremia) but inconclusive imaging results. Nonetheless, in the early phase of disease and suspicion of IE, it may be prudent to overdiagnose disease and perform echocardiography [5]. In the longer course of the disease, however, overtreatment of IE contributes to development of resistance of organisms in the microbiome and is associated with adverse events of antimicrobial agents [6].…”

Section: Discussionmentioning

confidence: 99%

Infective Endocarditis: How Do We Currently Interpret the Duke Minor Criterion “Predisposing Heart Condition” in Native Valves?

et al. 2016

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IntroductionThe term “predisposing heart condition” is used as an indication of antimicrobial prophylaxis to prevent infective endocarditis (IE) and as a criterion for diagnosing IE according to modified Duke criteria. The purpose of this survey was to elaborate clinician’s knowledge and opinion on relevant heart conditions as a Duke minor criterion for the diagnosis of IE.MethodsA questionnaire was created that consisted of two knowledge and two opinion questions on the term predisposing heart condition. The survey included results from 318 questionnaires with responses from specialists in the field of internal medicine, infectious diseases, and cardiology.ResultsThe answers of what participants believed to be currently a Duke minor criterion and what they thought should be minor criterion were very distributed with a median accordance of 33%.ConclusionThe survey indicates that there is significant uncertainty regarding what is encountered as a Duke minor criterion predisposing heart condition in a native valve.Electronic supplementary materialThe online version of this article (doi:10.1007/s40119-016-0074-2) contains supplementary material, which is available to authorized users.

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“…The cut-off of 20 hours for the time-to-positivity was chosen according to data from the VIRulence STAphylocoque (VIRSTA) study,17 in which about 90% of Staphylococcus aureus bacteremia (SAB) were positive in <20 hours after blood sampling. Median and 75th percentile were 13 and 18 hours after blood sampling.…”

Section: Methods and Designmentioning

confidence: 99%

Efficacy of cloxacillin versus cefazolin for methicillin-susceptibleStaphylococcus aureusbacteraemia (CloCeBa): study protocol for a randomised, controlled, non-inferiority trial

et al. 2018

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IntroductionMethicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia is a common and severe disease responsible for approximately 65 000 deaths every year in Europe. Intravenous antistaphylococcal penicillins (ASP) such as cloxacillin are the current recommended antibiotics. However, increasing reports of toxicity and recurrent stock-outs of ASP prompted healthcare providers to seek for alternative antibiotic treatment. Based on retrospective studies, cefazolin, a first-generation cephalosporin, is recommended in patients at risk of severe ASP-associated toxicity.We hypothesised that cefazolin has a non-inferior efficacy in comparison to cloxacillin, with a better safety profile for the treatment of MSSA bacteraemia.Methods and analysisThe CloCeBa trial is an open-label, randomised, controlled, non-inferiority trial conducted in academic centres throughout France. Eligible patients are adults with MSSA bacteraemia without intravascular device or suspicion of central nervous system infection. Patients will be randomised (1:1) to receive either cloxacillin or cefazolin by the intravenous route, for the first 14 days of therapy. The evaluation criteria is a composite criteria of negative blood cultures at day 5, survival, absence of relapse and clinical success at day 90 after randomisation. Secondary evaluation criteria include both efficacy and safety assessments. Three ancillary studies are planned to describe the epidemiology of β-lactamase encoding genes, the ecological impact and pharmacokinetic/pharmacodynamic parameters of cefazolin and cloxacillin. Including 300 patients will provide 80% power to demonstrate the non-inferiority of cefazolin over cloxacillin, assuming 85% success rate with cloxacillin and taking into account loss-to-follow-up, with a 0.12 non-inferiority margin and a one-sided type I error of 0.025.Ethics and disseminationThis protocol received authorisation from the ethics committee Sud-Est I on 13 November 2017 (2017-87-PP)and French National Agency for Medicines and Health Products (170661A-43). Results will be disseminated to the scientific community through congresses and publication in peer-reviewed journals.Trial registration numberNCT03248063 and 2017-003967-36.

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The VIRSTA score, a prediction score to estimate risk of infective endocarditis and determine priority for echocardiography in patients with Staphylococcus aureus bacteremia

Abstract: Physicians must be strongly encouraged to urgently perform echocardiography in SAB patients with a score ≥3 to establish IE diagnosis, to orient antimicrobial therapy and to help determine the need for valvular surgery.

Cited by 93 publications

References 28 publications

Benefit of Echocardiography in Patients With Staphylococcus aureus Bacteremia at Low Risk of Endocarditis

Benefit of Echocardiography in Patients With Staphylococcus aureus Bacteremia at Low Risk of Endocarditis

Infective Endocarditis: How Do We Currently Interpret the Duke Minor Criterion “Predisposing Heart Condition” in Native Valves?

Efficacy of cloxacillin versus cefazolin for methicillin-susceptibleStaphylococcus aureusbacteraemia (CloCeBa): study protocol for a randomised, controlled, non-inferiority trial

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