Echocardiograms in Bloodstream Infections
Indicated
- Staph aureus
Potentially Indicated
Non-beta-hemolytic streptococcus
IE is relatively uncommon (8.5%) in bacteremia with NBHS.
HANDOC score
- 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
Cutoff is 3 points.
- sensitivity 100%
- specificity 73-76%
Enterococcus faecalis
Enterococcal IE affects 4.29% of all episodes of E-BSI.
NOVA score
Number of positive cultures, Origin of infection unknown, Valve disease, and Auscultation of murmur
DENOVA score
+Long Duration of symptoms (≥ 7 days) and Embolization
NOVA (cutoff at ≥ 4)
sensitivity 100%; specificity 29%
DENOVA (cutoff at ≥ 3)
sensitivity 100%; specificity 85%
Candidemia
Infective endocarditis (IE) should be suspected in non-neutropenic patients with persistently positive blood cultures (with or without physical stigmata of IE), especially in the setting of predisposing conditions such as prior IE or injection drug use (IDU) [4]. In such cases, echocardiography should be pursued. In one study of 20 patients with Candida IE, 65 percent had a history of IDU and 55 percent had a prior episode of bacterial IE.
Routine echocardiography is not warranted for patients with candidemia in the absence of the above factors, given the rarity of this complication; in one study that included 187 adults with candidemia who underwent routine echocardiography, IE was diagnosed in 5.9 percent of cases
References
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Torgny Sunnerhagen, Amanda Törnell, Maria Vikbrant, Bo Nilson, Magnus Rasmussen, HANDOC: A Handy Score to Determine the Need for Echocardiography in Non-β-Hemolytic Streptococcal Bacteremia, Clinical Infectious Diseases, Volume 66, Issue 5, 1 March 2018, Pages 693–698, https://doi.org/10.1093/cid/cix880
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Sunnerhagen T, Højgaard Andersen M, Bruun NE, Bundgaard H, Iversen KK, Rasmussen M. External validation of the HANDOC score - high sensitivity to identify patients with non-beta-haemolytic streptococcal endocarditis. Infect Dis (Lond). 2020 Jan;52(1):54-57. doi: 10.1080/23744235.2019.1679388. Epub 2019 Oct 17. PMID: 31621444.