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HANDOC: A Handy Score to Determine the Need for Echocardiography in Non-β-Hemolytic Streptococcal Bacteremia
Torgny Sunnerhagen1, Amanda Törnell1, Maria Vikbrant1
1Department for Clinical Sciences Lund, Division of Infection Medicine, Medical Faculty, Lund University.
Insights
A new HANDOC score helps identify patients with non-β-hemolytic streptococci bacteremia who have a low risk of infective endocarditis (IE). This score can potentially reduce the need for echocardiography in diagnosing IE.
Area of Science:
- Cardiology
- Infectious Diseases
- Microbiology
Background:
- Non-β-hemolytic streptococci (NBHS) are a known cause of infective endocarditis (IE).
- Echocardiography is crucial for IE diagnosis, but its use in NBHS bacteremia requires better patient selection criteria.
Purpose of the Study:
- To develop and validate a clinical score (HANDOC) to identify patients with NBHS bacteremia at low risk for IE.
- To assess the potential of the HANDOC score to reduce unnecessary echocardiography.
Main Methods:
- Retrospective analysis of medical records from patients with NBHS bacteremia in southern Sweden (2012-2014).
- Development of the HANDOC score based on variables associated with IE in a training cohort.
- Validation of the HANDOC score in a separate cohort.
Main Results:
- The HANDOC score incorporates factors like heart murmur, specific streptococcal species, positive blood cultures, symptom duration, and infection source.
- In the training cohort, HANDOC achieved 100% sensitivity and 73% specificity for IE detection.
- In the validation cohort, HANDOC maintained 100% sensitivity and 76% specificity.
Conclusions:
- The HANDOC score effectively identifies patients with NBHS bacteremia who are unlikely to have IE.
- Implementing the HANDOC score could lead to a more judicious use of echocardiography, reducing healthcare costs and patient burden.
Background:
Non-β-hemolytic streptococci (NBHS) can cause infective endocarditis (IE). Echocardiography is used to diagnose IE, but it is not known which patients with NBHS bacteremia should undergo echocardiography.
Method:
Medical records of patients with NBHS bacteremia in southern Sweden from 2012 to 2014 were studied retrospectively. The patients were divided into 2 cohorts. In the first, correlations between the reported data and IE were studied. These variables were used to construct the HANDOC score, which was then validated in the second cohort.
Results:
Three hundred thirty-nine patients with NBHS bacteremia were included in the first cohort, of whom 26 fulfilled the criteria for IE. Several factors differed significantly between the patients with IE and those without. Among these variables, the presence of Heart murmur or valve disease; Aetiology with the groups of Streptococcus mutans, Streptococcus bovis, Streptococcus sanguinis, or Streptococcus anginosus; Number of positive blood cultures ≥2; Duration of symptoms of 7 days or more; Only 1 species growing in blood cultures; and Community-acquired infection were chosen to form the HANDOC score. With a cutoff between 2 and 3 points, HANDOC had a sensitivity of 100% and specificity of 73% in the first cohort. When tested in the validation cohort (n = 399), the sensitivity was 100% and the specificity 76%.
Conclusions:
HANDOC can be used in to identify patients with NBHS bacteremia who have a risk of IE so low that echocardiography can be omitted; therefore, its implementation might reduce the use of echocardiography.