title: Predicting Risk of Endocarditis Using a Clinical Tool (PREDICT): Scoring System to Guide Use of Echocardiography in the Management of Staphylococcus aureus Bacteremia.
abstract: BACKGROUND
  Infective endocarditis (IE) is a serious complication of Staphylococcus aureus bacteremia (SAB). There is limited clinical evidence to guide use of echocardiography in the management of SAB cases.
  
  
  METHODS
  Baseline and 12-week follow-up data of all adults hospitalized at our institution with SAB from 2006 to 2011 were reviewed. Clinical predictors of IE were identified using multivariable logistic regression analysis.
  
  
  RESULTS
  Of the 757 patients screened, 678 individuals with SAB (24% community acquired, 56% healthcare associated, and 20% nosocomial) met study criteria. Eighty-five patients (13%) were diagnosed with definite IE within the 12 weeks of initial presentation based on modified Duke criteria. The proportion of patients with IE was 22% (36/166) in community-acquired SAB, 11% (40/378) in community-onset healthcare-associated SAB, and 7% (9/136) in nosocomial SAB. Community-acquired SAB, presence of cardiac device, and prolonged bacteremia (≥ 72 hours) were identified as independent predictors of IE in multivariable analysis. Two scoring systems, day 1 (SAB diagnosis day) and day 5 (when day 3 culture results are known), were derived based on the presence of these risk factors, weighted in magnitude by the corresponding regression coefficients. A score of ≥ 4 for day 1 model had a specificity of 96% and sensitivity of 21%, whereas a score of <2 for day 5 model had a sensitivity of 98.8% and negative predictive value of 98.5%.
  
  
  CONCLUSIONS
  We propose 2 novel scoring systems to guide use of echocardiography in SAB cases. Larger prospective studies are needed to validate the classification performance of these scoring systems.
authors: Division of Infectious Diseases.
authors: Bharath Raj
authors: BR
authors: Palraj
authors: Division of Infectious Diseases Division of Cardiovascular Diseases, Department of Medicine.
authors: Larry M
authors: LM
authors: Baddour
authors: Department of Emergency Medicine and Center for Science of Healthcare Delivery.
authors: Erik P
authors: EP
authors: Hess
authors: Division of Infectious Diseases.
authors: James M
authors: JM
authors: Steckelberg
authors: Division of Infectious Diseases.
authors: Walter R
authors: WR
authors: Wilson
authors: Department of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors: Brian D
authors: BD
authors: Lahr
authors: Division of Infectious Diseases Division of Cardiovascular Diseases, Department of Medicine.
authors: M Rizwan
authors: MR
authors: Sohail
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000150:complications* / Q000473:pathology*; D003661:Decision Support Techniques; D003955:Diagnostic Tests, Routine; D004452:Echocardiography; D004696:Endocarditis / Q000175:diagnosis* / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000150:complications* / Q000473:pathology*; D055815:Young Adult
keywords: Staphylococcus aureus; bacteremia; echocardiography; endocarditis; risk score