Tubiana et al reported teh VIRSTA score for a patient with Staphylococcus aureus bacteremia. This can help to identify a patient who should undergo transesophageal echocardiography. The authors are from the VIRSTA/AEPEI Study group, involving multiple hospitals in France.
Patient selection: Staphylococcus aureus bacteremia
Parameters:
(1) cerebral or peripheral emboli
(2) meningitis
(3) permanent intracardiac device or previous infective endocarditis
(4) pre-existing native valve disease
(5) intravenous drug use
(6) persistent bacteremia with Staphylococcus aureus
(7) vertebral osteomyelitis
(8) community or non-nosocomial health care associated acquisition
(9) severe sepsis or shock
(10) C-reactive protein (CRP) > 190 mg/L
|
Parameter |
Finding |
Points |
|
cerebral or peripheral emboli |
No |
0 |
|
|
Yes |
5 |
|
meningitis |
No |
0 |
|
|
yes |
5 |
|
previous history |
permanent intracardiac device |
4 |
|
|
history of previous infective endocarditis |
4 |
|
|
neither |
0 |
|
pre-existing native valve disease |
No |
0 |
|
|
yes |
3 |
|
intravenous drug use |
No |
0 |
|
|
yes |
4 |
|
persistent bacteremia |
No |
0 |
|
|
yes |
3 |
|
vertebral osteomyelitis |
No |
0 |
|
|
yes |
2 |
|
acquisition |
nosocomial |
0 |
|
|
other (community, non-nosocomial HCA) |
2 |
|
severe sepsis or shock |
No |
0 |
|
|
yes |
1 |
|
CRP |
<= 190 mg/L |
0 |
|
|
> 190 mg/L |
1 |
total score =
= SUM(points for all 10 parameters)
Interpretation:
• minimum score: 0
• maximum score: 30
• The higher the score the greater the positive predictive value for infective endocarditis.
• A score >= 3 is an indication for transesophageal echocardiography.
Performance:
• A score >= 3 has a negative predictive value of 0.988, a sensitivity of 96% and specificity of 44%
Specialty: Infectious Diseases, Cardiology
