Key result
Among patients with a cardiac implantable electronic device and Staphylococcus aureus bacteraemia, a CTEPP score ≥2 points strongly predicted infective endocarditis (OR 12) with 97% sensitivity and 98% negative predictive value.
Why the study?
Patients with a CIED and Staphylococcus aureus bacteraemia are at risk for infective endocarditis, prompting the need to describe this population, identify risk factors, and construct a predictive score.
Can the CTEPP score predict the risk of infective endocarditis in patients with cardiac implantable electronic devices and Staphylococcus aureus bacteraemia?
Cohort (n=274)
Can the CTEPP score predict the risk of infective endocarditis in patients with cardiac implantable electronic devices and Staphylococcus aureus bacteraemia?
Odds Ratio: 12 (95% CI 1.6–90)
p-value: p=0.002
The CTEPP score is a highly sensitive tool with a 98% negative predictive value for ruling out infective endocarditis in patients with CIEDs and Staphylococcus aureus bacteraemia.
May aid IE risk stratification in CIED-SAB patients; leaves open clinical use pending prospective validation.
Patients with cardiac implantable electronic device (CIED) and Staphylococcus aureus bacteraemia (SAB) are at risk of having infective endocarditis (IE). The objectives were to describe a Swedish population-based cohort of patients with CIED and SAB, to identify risk factors, and to construct a predictive score for IE. Patients over 18 years old in the Stockholm Region identified to have SAB in the Karolinska Laboratory database from January 2015 through December 2019 were matched to the Swedish Pacemaker and Implantable Cardioverter-Defibrillator ICD Registry to identify the study cohort. Data were collected from study of medical records. A cohort of 274 patients with CIED and SAB was identified and in 38 episodes (14%) IE were diagnosed, 19 with changes on the CIED, and 35 with changes on the left side of the heart. The risk factors predisposition for IE, community acquisition, embolization, time to positivity of blood cultures, and growth in blood culture after start of therapy in blood cultures were independently associated to IE. A score to identify patients with IE was constructed, the CTEPP score, and the chosen cut-off generated a sensitivity of 97%, specificity of 25%, and a negative predictive value of 98%. The score was externally validated in a population-based cohort of patients with CIED and SAB from another Swedish region. We found that 14% of patients with CIED and SAB had definite IE diagnosed. The CTEPP-score can be used to predict the risk of IE and, when negative, the risk is negligible.
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Berge et al. (2023) conducted a cohort in Staphylococcus aureus bacteraemia in patients with cardiac implantable electronic devices (n=274). CTEPP score ≥2 points vs. CTEPP score <2 points was evaluated on Definite infective endocarditis (OR 12, 95% CI 1.6-90, p=0.002). Among patients with a cardiac implantable electronic device and Staphylococcus aureus bacteraemia, a CTEPP score ≥2 points strongly predicted infective endocarditis (OR 12) with 97% sensitivity and 98% negative predictive value.
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