title: The VIRSTA score, a prediction score to estimate risk of infective endocarditis and determine priority for echocardiography in patients with Staphylococcus aureus bacteremia.
abstract: OBJECTIVE
  To develop and validate a prediction score, to quantify, within 48 h of Staphylococcus aureus bacteremia (SAB) diagnosis, the risk of IE, and therefore determine priority for urgent echocardiography.
  
  
  METHODS
  Consecutive adult patients with SAB in 8 French university hospitals between 2009 and 2011 were prospectively enrolled and followed-up 3 months. A predictive model was developed and internally validated using bootstrap procedures.
  
  
  RESULTS
  Among the 2008 patients enrolled, 221 (11.0%) had definite IE of whom 39 (17.6%) underwent valve surgery, 25% of them within 6 days of SAB diagnosis. Ten predictors independently associated with IE were used to build up the prediction score: intracardiac device or previous IE, native valve disease, intravenous drug use, community or non-nosocomial-acquisition, cerebral or extracerebral emboli, vertebral osteomyelitis, severe sepsis, meningitis, C-reactive protein above 190 mg/L, and H48-persistent bacteremia. Patients with a score ≤2 (n = 792, 39.4%) were at low IE-risk (1.1%; negative predictive value: 98.8% (95% CI, 98.4-99.4)) compared to those ≥3 who were at higher risk (17.4%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: IAME, Inserm UMR 1137, Univ. Paris Diderot, Sorbonne Paris Cité, Paris, France; Inserm Clinical Investigation Center 1425, Paris, France.
authors.forename: Sarah
authors.initials: S
authors.lastname: Tubiana
authors.affiliation: IAME, Inserm UMR 1137, Univ. Paris Diderot, Sorbonne Paris Cité, Paris, France; Inserm Clinical Investigation Center 1425, Paris, France. Electronic address: xavier.duval@bch.aphp.fr.
authors.forename: Xavier
authors.initials: X
authors.lastname: Duval
authors.affiliation: Université de Lorraine, Université Paris Descartes, Apemac, EA 4360, France; Inserm, CIC-EC, CIE6, Nancy, F-54000, France; CHU Nancy, Pôle S2R, Épidémiologie et Évaluation Cliniques, Nancy, F-54000, France.
authors.forename: François
authors.initials: F
authors.lastname: Alla
authors.affiliation: Centre Hospitalier Universitaire de Nancy, Nancy, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Selton-Suty
authors.affiliation: Hôpital Pontchaillou, Inserm U835, Faculté de Médecine, Université Rennes 1, IFR140, Rennes, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Tattevin
authors.affiliation: Hospices Civils de Lyon, Université Claude Bernard, Lyon, France.
authors.forename: François
authors.initials: F
authors.lastname: Delahaye
authors.affiliation: CHU de Dijon, UMR 1347-MERS, Université de Bourgogne, Dijon, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Piroth
authors.affiliation: UMR CNRS 6249 Chrono-environnement, Université de Franche-Comté, CHU de Besançon, Besançon, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Chirouze
authors.affiliation: CHU Carémeau, INSERM U1047, Université Montpellier 1, Nîmes, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Lavigne
authors.affiliation: Inserm, CIC-EC, CIE6, Nancy, F-54000, France; Centre Hospitalier Universitaire de Nancy, Nancy, France.
authors.forename: Marie-Line
authors.initials: ML
authors.lastname: Erpelding
authors.affiliation: Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, EA 4537, France; Centre Hospitalier Universitaire de Pointe-à-Pitre, Inserm CIC1424, Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne, Pointe-à-Pitre, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Hoen
authors.affiliation: Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Centre International de Recherche en Infectiologie, INSERM U1111, Université Lyon 1, CNRS, UMR 5308, Lyon, France.
authors.forename: François
authors.initials: F
authors.lastname: Vandenesch
authors.affiliation: Cardiology Department, AP-HP, Bichat Hospital Paris, France; DHU Fire, Paris, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.affiliation: CHU de Montpellier, UMI 233 Université Montpellier 1, Institut de Recherche pour le Développement, Montpellier, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Le Moing
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D004452:Echocardiography; D004696:Endocarditis / Q000175:diagnosis*; D005602:France; D006321:Heart / Q000000981:diagnostic imaging*; D006785:Hospitals, University; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D055815:Young Adult
keywords: Echocardiography; Infective endocarditis; Prognostic score; Staphylococcus aureus bacteremia; VIRSTA score