Unit of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
Infection. 2019 Feb;47(1):45-50. doi: 10.1007/s15010-018-1208-3. Epub 2018 Sep 3.
Enterococcal bacteremia can be complicated by infective endocarditis (IE) and when suspected, transesophageal echocardiography (TEE) should be performed. The previously published NOVA score can identify patients with enterococcal bacteremia at risk for IE and we aimed to improve the score.
Factors associated with IE were studied retrospectively in a population-based cohort of patients with monomicrobial Enterococcus faecalis bacteremia (MEFsB). Factors associated with IE in multivariable analysis were included in a new score system which was compared to the NOVA score and validated in a cohort of patients with MEFsB from another region.
Among 397 episodes of MEFsB, 44 episodes with IE were compared to those without IE. Long Duration of symptoms (≥ 7 days) and Embolization were associated with IE in the multivariate analysis and hence were added to the NOVA variables (Number of positive cultures, Origin of infection unknown, Valve disease, and Auscultation of murmur) to generate a novel score; DENOVA. The area under the curve in ROC analyses was higher for DENOVA (0.95) compared to NOVA (0.91) (p = 0.001). With a cutoff at ≥ 3 positive variables the DENOVA score has a sensitivity of 100% and specificity of 83% which is superior to the NOVA score (specificity 29%). The DENOVA score was applied to the validation cohort (26 IE episodes and 256 non-IE episodes) and the resulting sensitivity was 100% and the specificity was 85% compared to 35% for NOVA.
The DENOVA score is a useful tool to identify patients with MEFsB where TEE is not needed.
肠球菌菌血症可并发感染性心内膜炎（IE），当怀疑发生 IE 时，应进行经食管超声心动图（TEE）检查。先前发表的 NOV A 评分可识别肠球菌菌血症患者并发 IE 的风险，我们旨在改进该评分。
我们回顾性研究了单一致病菌性粪肠球菌菌血症（MEFsB）患者的人群队列中与 IE 相关的因素。多变量分析中与 IE 相关的因素被纳入一个新的评分系统，该评分系统与 NOV A 评分进行了比较，并在另一地区的 MEFsB 患者队列中进行了验证。
在 397 例 MEFsB 中，有 44 例并发 IE，与无 IE 患者进行了比较。症状持续时间较长（≥7 天）和栓塞与多变量分析中的 IE 相关，因此将其添加到 NOV A 变量（阳性培养物数量、感染来源不明、瓣膜疾病和杂音听诊）中，以生成一个新的评分；DENOVA。ROC 分析中 DENOVA 的曲线下面积（AUC）高于 NOV A（0.95 对 0.91）（p=0.001）。DENOVA 评分的截断值≥3 个阳性变量时，其灵敏度为 100%，特异性为 83%，优于 NOV A 评分（特异性 29%）。DENOVA 评分应用于验证队列（26 例 IE 病例和 256 例非 IE 病例），其灵敏度为 100%，特异性为 85%，而 NOV A 为 35%。
DENOVA 评分是一种有用的工具，可以识别需要 TEE 的 MEFsB 患者。
