Related Experiment Video
Updated: Feb 20, 2026
Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
Risk assessment for infected endocarditis in Staphylococcus aureus bacteremia patients: When is transesophageal
Luca Longobardo1, Sarah Klemm2,3, Margaret Cook2,3
11 Department of Clinical and Experimental Medicine - Section of Cardiology, University of Messina, Italy.
Insights
A modified scoring system effectively identifies patients with Staphylococcus aureus bacteremia (SAB) at high risk for endocarditis, guiding the use of transesophageal echocardiography (TEE). Including intravenous drug abuse (IVDA) improves risk stratification for infective endocarditis.
Area of Science:
- Cardiology
- Infectious Diseases
- Diagnostic Imaging
Background:
- Echocardiography is crucial for diagnosing endocarditis in Staphylococcus aureus bacteremia (SAB) patients.
- Current guidelines lack consensus on using transthoracic echocardiography (TTE) versus transesophageal echocardiography (TEE) as the initial diagnostic test.
- A novel scoring system by Palraj et al. was proposed to guide TEE utilization in SAB patients.
Purpose of the Study:
- To validate and potentially modify the Palraj scoring system for identifying SAB patients at high risk of endocarditis.
- To identify additional clinical predictors of endocarditis in the SAB population.
- To improve the diagnostic accuracy of risk stratification for infective endocarditis.
Main Methods:
- Retrospective analysis of SAB patients admitted between 2012 and 2014.
- Validation of the Palraj scoring system to stratify endocarditis risk.
- Identification of novel clinical predictors through population analysis.
- Development of two modified scoring systems (Day-1 and Day-5) incorporating intravenous drug abuse (IVDA).
Main Results:
- Endocarditis was diagnosed in 18.5% (38/205) of SAB patients.
- The Palraj score effectively identified high-risk patients.
- Cardiac devices, prolonged bacteremia, and IVDA were significant predictors of endocarditis.
- The modified Palraj's score demonstrated high sensitivity (97.0%) for Day-5 scores and good specificity (88.6%) for Day-1 scores.
Conclusions:
- The modified Palraj scoring system enhances the identification of SAB patients requiring TEE for endocarditis diagnosis.
- Incorporating IVDA into the scoring criteria significantly improves its effectiveness in risk stratification.
- This validated and modified score aids in optimizing TEE use for infective endocarditis detection in SAB.
Aims:
Echocardiography is the main technique for the diagnosis of endocarditis in patients with Staphylococcus aureus bacteremia (SAB), but a consensus about performing transthoracic echocardiography or transesophageal echocardiography (TEE) as first-line tests is currently lacking. Recently, a new scoring system has been proposed by Palraj et al. to guide the use of TEE in this population. Our aim was to validate this scoring system or modify it, if necessary.
Methods And Results:
Data from SAB patients admitted from 2012 to 2014 were collected. We tested the Palraj scores to stratify patients' risk for endocarditis. Moreover, we analyzed our population to identify any other possible clinical predictors of endocarditis not included in the score. Endocarditis was diagnosed in 38 of 205 patients (18.5%). Palraj's score was effective in the detection of patients at high risk of endocarditis. In addition, we identified the presence of cardiac devices, prolonged bacteremia and intravenous drug abuse (IVDA) as elements strongly correlated with endocarditis. Two scoring systems (Day-1 and Day-5) were derived including IVDA as a variable. Using a Day-1 cut-off value ≥5 and a Day-5 cut-off value ≥2, the 'modified Palraj's score' showed sensitivities of 42.1% and 97.0% and specificities of 88.6% and 32.0% for Day-1 and Day-5 scores, respectively.
Conclusion:
We modify and expand upon an effective scoring system to identify SAB patients at high risk for endocarditis in order to guide use of TEE. The inclusion of IVDA in the criteria for the calculation of the scores improves its effectiveness.
Related Concept Videos
01:18Endocarditis III: Medical Management
01:25Endocarditis I: Introduction
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
01:29Endocarditis IV: Nursing Management
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for...