Echocardiograms in Bloodstream Infections

Indicated

  1. 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

  1. 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

  2. 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.