SPC365

Should we trust scores to rule out transesophagic echocardiography in patients with Staphylococcus aureus bacteriemia?

Session: Posters (Sessão 1 - Écran 7) - Miscelânea - Vários Temas
Speaker: Ana Beatriz Garcia

Congress: CPC 2022
Topic: P. Other
Theme: 37. Miscellanea
Subtheme: 16.6 Infective Endocarditis – Clinical
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Ana Beatriz Garcia; Pedro Silvério António; Sara Couto Pereira; Joana Brito; Beatriz Valente Silva; Pedro Alves da Silva; Catarina Oliveira; Ana Margarida Martins; Ana Abrantes; Miguel Azaredo Raposo; João Fonseca; Catarina Gregório; Pedro Carrilho Ferreira; Fausto j. Pinto

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><em>Staphylococcus aureus</em></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> remains the most frequent pathogen in infectious endocarditis (IE) with high mortality and complication rates, despite widespread prophylaxis, </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212121"><span style="background-color:#ffffff">diagnostic and therapeutic procedures.&nbsp;</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212121"><span style="background-color:#ffffff">Due to the high frequency of IE and its potential complications, current ESC guidelines recommend routine echocardiographic examination in pts with S. aureus bacteriemia (SAB), with either TTE or TOE. Despite higher sensitivity, TOE is an invasive method, not widely available and thus patient selection is key.&nbsp; </span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Recently, three scores have been proposed to best select pts with SAB who may not need TOE if deemed low risk.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: To validate the diagnostic accuracy of three predictive scores in a population of pts with SAB.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Single center observational study, of 79 pts with SAB who performed TOE for EI diagnosis. Clinical and laboratory characteristics were collected at baseline. Three diagnostic scores &ndash; POSITIVE, PREDICT and VIRSTA &ndash; were calculated for every patient and results were compared using Chi-square and Mann-Whitney tests.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: We compared 21 pts with EI vs 53 pts with bacteriemia only. There were no statistical significant differences in demographic (mean age 64&plusmn;15years vs 65&plusmn;16years, p=0.876; 66% males vs 79%; p=0.45), clinical and echocardiographic features. No significant difference in baseline characteristics regarding prosthesis, implantable devices or other risk factors, such as iv drug use.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">We applied the predictor scores to both groups and saw no statistical differences between them &ndash; PREDICT 2.55 &plusmn; 1.1 vs 2,92 &plusmn; 1.54, p=0.350; VIRSTA 3.96 &plusmn; 2.65 vs 4.55 &plusmn; 2.79 p=0.293; POSITIVE 1.41 &plusmn; 2.16 vs 2.00 &plusmn; 2.50 p=0.317).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">No other variables were predictors of endocarditis, except for bicuspid aortic valve which associated with higher risk (p=0.044).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">When analysing outcomes in these two groups we noted a higher rate of complications in pts with IE: cerebral embolic events - 3 stroke and 2 silent embolic event (SEE) in comparison with just 3 events on the other group (1 stroke and 2 SEE), p=0.029 &ndash; and need for mechanical ventilation during hospitalization (15% vs 2.1%, p=0.042).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In our population we did not find these scores able to accurately classify SAB pts as low risk and thus safely exclude TOE from diagnostic approach. Given the high risk of complications associated with IE, clinical evaluation, lab tests and imaging should be integrated to best select the right method for each patient</span></span></span></p>