The NOVA score: a proposal to reduce the need for transesophageal echocardiography in patients with enterococcal bacteremia.
Frequency of enterococcal bloodstream infection (E-BSI) is increasing, and the number of episodes complicated by infective endocarditis (IE) varies. Performing transesophageal echocardiography (TEE) in all patients with E-BSI is costly and time-consuming. Our objectives were to identify patients with E-BSI who are at very low risk of enterococcal IE (and therefore do not require TEE) and to compare the outcome of E-BSI in patients with/without IE.



Between September 2003 and October 2012, we performed a prospective cohort study (all patients with E-BSI) and a case-control study (patients with/without enterococcal IE) in our center.



We detected 1515 patients with E-BSI and 65 with enterococcal IE (4.29% of all episodes of E-BSI, 16.7% of patients with E-BSI who underwent transthoracic echocardiography, and 35.5% of all patients with E-BSI who underwent TEE). We developed a bedside predictive score for enterococcal IE-Number of positive blood cultures, Origin of the bacteremia, previous Valve disease, Auscultation of heart murmur (NOVA) score-based on the following variables: Number of positive blood cultures (3/3 blood cultures or the majority if more than 3), 5 points; unknown Origin of bacteremia, 4 points; prior heart Valve disease, 2 points; Auscultation of a heart murmur, 1 point (receiver operating characteristic = 0.83). The best cutoff corresponded to a score ≥4 (sensitivity, 100%; specificity, 29%). A score <4 points suggested a very low risk for enterococcal IE and that TEE could be obviated.



Enterococcal IE may be more frequent than generally thought. Depending on local prevalence of endocarditis, application of the NOVA score may safely obviate echocardiography in 14%-27% of patients with E-BSI.
Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón Centros de Investigación Biomédica en Red Enfermedades Respiratorias Medicine Department, School of Medicine, Universidad Complutense de Madrid Instituto de Investigación Sanitaria Gregorio Marañón.
Emilio
E
Bouza
Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón Medicine Department, School of Medicine, Universidad Complutense de Madrid Instituto de Investigación Sanitaria Gregorio Marañón.
Martha
M
Kestler
Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón.
Teresa
T
Beca
Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón.
Gabriel
G
Mariscal
Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón.
Marta
M
Rodríguez-Créixems
Medicine Department, School of Medicine, Universidad Complutense de Madrid Instituto de Investigación Sanitaria Gregorio Marañón Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Javier
J
Bermejo
Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón.
Ana
A
Fernández-Cruz
Medicine Department, School of Medicine, Universidad Complutense de Madrid Instituto de Investigación Sanitaria Gregorio Marañón Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Francisco
F
Fernández-Avilés
Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón Centros de Investigación Biomédica en Red Enfermedades Respiratorias Medicine Department, School of Medicine, Universidad Complutense de Madrid Instituto de Investigación Sanitaria Gregorio Marañón.
Patricia
P
Muñoz
D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000150:complications*; D001769:Blood / Q000382:microbiology; D016022:Case-Control Studies; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal / Q000706:statistics & numerical data; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016983:Enterococcus / Q000302:isolation & purification; D013293:Enterococcus faecalis / Q000302:isolation & purification*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D006337:Heart Murmurs; D006349:Heart Valve Diseases; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain; D055815:Young Adult
Enterococcus spp.; bacteremia; endocarditis