title: Simplified risk stratification criteria for identification of patients with MRSA bacteremia at low risk of infective endocarditis: implications for avoiding routine transesophageal echocardiography in MRSA bacteremia.
abstract: The aim of this study was to identify patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia with low risk of infective endocarditis (IE) who might not require routine trans-esophageal echocardiography (TEE). We retrospectively evaluated 398 patients presenting with MRSA bacteremia for the presence of the following clinical criteria: intravenous drug abuse (IVDA), long-term catheter, prolonged bacteremia, intra-cardiac device, prosthetic valve, hemodialysis dependency, vertebral/nonvertebral osteomyelitis, cardio-structural abnormality. IE was diagnosed using the modified Duke criteria. Of 398 patients with MRSA bacteremia, 26.4 % of cases were community-acquired, 56.3 % were health-care-associated, and 17.3 % were hospital-acquired. Of the group, 44 patients had definite IE, 119 had possible IE, and 235 had a rejected diagnosis. Out of 398 patients, 231 were evaluated with transthoracic echocardiography (TTE) or TEE. All 44 patients with definite IE fulfilled at least one criterion (sensitivity 100 %). Finally, a receiver operator characteristic (ROC) curve was obtained to evaluate the total risk score of our proposed criteria as a predictor of the presence of IE, and this was compared to the ROC curve of a previously proposed criteria. The area under the ROC curve for our criteria was 0.710, while the area under the ROC curve for the criteria previously proposed was 0.537 (p < 0.001). The p-value for comparing those 2 areas was less than 0.001, indicating statistical significance. Patients with MRSA bacteremia without any of our proposed clinical criteria have very low risk of developing IE and may not require routine TEE.
authors.affiliation: Division of Internal Medicine, Boston Medical Center, 801 Massachusetts Ave Crosstown, 2nd Floor, Boston, MA, 02118, USA. pbuitro1@bu.edu.|Boston University, Boston, MA, USA. pbuitro1@bu.edu.
authors.forename: P
authors.initials: P
authors.lastname: Buitron de la Vega
authors.affiliation: Division of Internal Medicine, Ottawa Hospital, Ottawa, ON, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Tandon
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA.
authors.forename: W
authors.initials: W
authors.lastname: Qureshi
authors.affiliation: Heart and Vascular Institute, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Nasr
authors.affiliation: Government Kilpauk Medical College Hospital, Chennai, India.
authors.forename: R
authors.initials: R
authors.lastname: Jayaprakash
authors.affiliation: Division of Infectious Diseases, Henry Ford Health System, Detroit, MI, USA.
authors.forename: S
authors.initials: S
authors.lastname: Arshad
authors.affiliation: Division of Infectious Diseases, Henry Ford Health System, Detroit, MI, USA.
authors.forename: D
authors.initials: D
authors.lastname: Moreno
authors.affiliation: Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA.
authors.forename: G
authors.initials: G
authors.lastname: Jacobsen
authors.affiliation: Wayne State University School of Medicine, Detroit, MI, USA.|Heart and Vascular Institute, Henry Ford Health System, Detroit, MI, USA.
authors.forename: K
authors.initials: K
authors.lastname: Ananthasubramaniam
authors.affiliation: Division of Infectious Diseases, Henry Ford Health System, Detroit, MI, USA.|Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: M
authors.initials: M
authors.lastname: Ramesh
authors.affiliation: Division of Infectious Diseases, Henry Ford Health System, Detroit, MI, USA.|Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: M
authors.initials: M
authors.lastname: Zervos
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000175:diagnosis / Q000382:microbiology*; D002408:Catheters, Indwelling; D017147:Defibrillators, Implantable; D017548:Echocardiography, Transesophageal / Q000379:methods*; D004697:Endocarditis, Bacterial / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D012306:Risk; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000401:mortality; D015819:Substance Abuse, Intravenous