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Evaluation of the MEFIER Score in Identifying Patients at High Risk of Endocarditis in Enterococcus faecalis

Virgile Zimmermann1, Nicolas Fourré1, Pierre Monney2

  • 1Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

Open Forum Infectious Diseases
|April 10, 2026
PubMed

Insights

The DENOVi score effectively identifies low-risk Enterococcus faecalis bacteremia patients, unlike the MEFIER score. DENOVi reduces unnecessary echocardiograms by accurately ruling out infective endocarditis.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Clinical Microbiology

Background:

  • Enterococcus faecalis bacteremia poses a risk for infective endocarditis (IE).
  • Accurate risk stratification is crucial to guide diagnostic workups, including echocardiography.

Purpose of the Study:

  • To compare the diagnostic performance of the MEFIER and DENOVi scores in ruling out IE in Enterococcus faecalis bacteremia.
  • To evaluate the potential of these scores in reducing unnecessary echocardiographic examinations.

Main Methods:

  • Retrospective cohort study of 549 Enterococcus faecalis bacteremia episodes.
  • Analysis of MEFIER and DENOVi score performance using negative likelihood ratios.
  • Assessment of misclassification rates for infective endocarditis.

Main Results:

  • The MEFIER score demonstrated poor rule-out performance for IE (negative likelihood ratio = 0.69), misclassifying 60% of IE episodes.
  • The DENOVi score showed significantly better performance (negative likelihood ratio = 0.07), misclassifying only 5% of IE episodes.
  • DENOVi score's accuracy suggests potential for avoiding unnecessary echocardiography.

Conclusions:

  • The DENOVi score is a superior tool for ruling out infective endocarditis in Enterococcus faecalis bacteremia compared to the MEFIER score.
  • Implementing the DENOVi score can help optimize the use of echocardiography, reducing healthcare costs and patient burden.
Keywords:
Enterococcus faecalisNOVA scorebacteremiainfective endocarditispredictive score

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