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Validation of the VIRSTA and VIRSTA+ Scores to Identify Patients with Staphylococcus aureus Bacteremia at Very Low

Daniela Malano-Barletta1, Miguel Ángel Verdejo1, Guillermo Cuervo2,3

  • 1Infectious Diseases Department, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.

Infectious Diseases and Therapy
|April 30, 2026
PubMed

Insights

The VIRSTA and VIRSTA+ scores effectively identify low-risk patients with Staphylococcus aureus bacteremia (SAB), showing high negative predictive value for infective endocarditis (IE). These tools can guide echocardiography decisions in clinical practice.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Diagnostics

Background:

  • Adherence to echocardiography guidelines for Staphylococcus aureus bacteremia (SAB) varies.
  • Risk stratification is needed to optimize transthoracic echocardiography (TTE) use.
  • The VIRSTA and VIRSTA+ scores aim to identify low-risk SAB patients for potential IE.

Purpose of the Study:

  • Validate VIRSTA and VIRSTA+ scores for risk stratification in SAB patients.
  • Assess the utility of these scores in prioritizing TTE.
  • Identify patients at low risk for infective endocarditis (IE).

Main Methods:

  • Retrospective analysis of a prospectively assembled cohort of adult SAB patients (2006-2022).
  • Exclusion criteria included lack of echocardiogram, early death, pre-culture antibiotics, and missing time to positivity (TTP).
  • VIRSTA and VIRSTA+ scores were calculated; diagnostic performance for IE was assessed using modified Duke criteria.

Main Results:

  • Included 798 SAB episodes; median TTP was 8h for IE vs. 12h for non-IE.
  • VIRSTA ≥ 3 had 19% IE rate (sensitivity 99%, NPV 99.5%).
  • VIRSTA+ achieved 100% NPV for IE, with one IE case having VIRSTA < 3 and TTP < 11.5h.

Conclusions:

  • VIRSTA and VIRSTA+ scores demonstrate high negative predictive value in SAB patients.
  • These scores can aid in risk stratification and guide clinical decision-making for TTE.
  • Potential utility in resource-constrained settings for prioritizing echocardiography.
Abstract

Keywords:
Staphylococcus aureus bacteremiaComplicated bacteremiaEchocardiographyEndocarditisRisk stratification

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