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Master Thesis

Évaluation des scores pronostiques d’endocardite infectieuse dans les bactériémies à Staphylococcus aureus : une étude prospective

Abstract : Background: Staphylococcus aureus is a frequent cause of bacteremia with a high mortality rate. In 5 to 20% of cases, bacteremia is complicated by infective endocarditis, the diagnosis is sometimes complex and depends on a number of factors. In addition to blood cultures, echocardiography is a key diagnostic test and is recommended for all episodes of Staphylococcus aureus bacteremia, although this is widely debated. Several predictive scores of infective endocarditis have been established and evaluated on retrospective series. Our objective is to evaluate the diagnostic performance of the PREDICT, VIRSTA and POSITIVE scores on a prospective series at the Grenoble Alpes University Hospital. Methods: All patients with a positive Staphylococcus aureus blood culture from July 22, 2020 to July 21, 2021 were prospectively included. For each patient the three scores were calculated. The performance of the scores was evaluated for their ability to diagnose definite endocarditis according to the modified Duke criteria. Results: We analyzed 123 episodes of bacteremia occurring in as many patients, 22% had a cardiac predisposition, 3.3% had intravenous drug use, in 26.8% the bacteremia was community-acquired, 4.1% of the Staphylococcus aureus were resistant to meticillin. Transthoracic echocardiography was performed in 89.4% of patients and transesophageal echocardiography in 27.6%. Definite endocarditis according to the Duke criteria was diagnosed in 15 patients (12.2%). Sensitivity was 100% for VIRSTA and PREDICT at D5, 80% for POSITIVE. The negative predictive value was 100% for VIRSTA and PREDICT at D5, 96.2% for POSITIVE. Discriminatory capacity evaluated by the area under the ROC curve was 91.7 for VIRSTA, 88 for PREDICT at day 5, 82.6 for POSITIVE, 70.3 for PREDICT at day 1. The proportion of patients classified as high risk was 36.6% for POSITIVE, 39.8% for PREDICT at D5 and 63.4% for VIRSTA. Conclusions: The VIRSTA score seems to have the best diagnostic performance and can be used to determine patients at low risk of endocarditis in whom echocardiography could be dispensed with. It could be completed by the PREDICT score at day 1 and day 5 to accurately identify patients in whom echocardiography is mandatory, but further studies are needed to validate this algorithm.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03412777
Contributor : Jean-Hugues Morneau Connect in order to contact the contributor
Submitted on : Wednesday, November 3, 2021 - 12:14:41 PM
Last modification on : Friday, November 5, 2021 - 3:45:25 AM

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  • HAL Id : dumas-03412777, version 1

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Clémentin Vignau. Évaluation des scores pronostiques d’endocardite infectieuse dans les bactériémies à Staphylococcus aureus : une étude prospective. Médecine humaine et pathologie. 2021. ⟨dumas-03412777⟩

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