BACT-URIE: A Novel Score Integrating Bacteriuria to Predict Infective Endocarditis in Patients With Staphylococcus...

Area of Science:

• Infectious Diseases
• Cardiology
• Clinical Microbiology

Background:

• Infective endocarditis (IE) is a severe complication of Staphylococcus aureus bacteremia (SAB).
• Current risk stratification for IE is resource-intensive and may not fully capture hematogenous spread markers.
• Staphylococcus aureus bacteriuria is a potential indicator of IE not included in existing risk scores.

Purpose of the Study:

• To assess the utility of Staphylococcus aureus bacteriuria in improving IE risk stratification among SAB patients.
• To develop and validate a novel risk score (BACT-URIE) for predicting IE in SAB.

Main Methods:

• Retrospective analysis of two distinct adult SAB patient cohorts (derivation and validation).
• Logistic regression identified independent predictors of IE, including bacteriuria.
• Two risk scores were developed: a day 1 score (baseline) and a day 4 score (including persistent bacteremia).
• Performance was compared against existing scores like VIRSTA and PREDICT.

Main Results:

• Infective endocarditis occurred in 14.6% and 14.7% of derivation and validation cohorts, respectively.
• Independent predictors of IE included intracardiac devices, community acquisition, bacteriuria, septic emboli, and persistent bacteremia.
• The BACT-URIE scores demonstrated strong predictive performance (AUROCs 0.78-0.93) and higher sensitivity compared to VIRSTA and PREDICT.

Conclusions:

• The BACT-URIE score, incorporating Staphylococcus aureus bacteriuria, shows promise for predicting IE in SAB patients.
• This exploratory score may aid in identifying patients at high risk for IE.
• Prospective multicenter validation is necessary before clinical implementation of BACT-URIE.