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BACT-URIE: A Novel Score Integrating Bacteriuria to Predict Infective Endocarditis in Patients With Staphylococcus aureus Bacteremia

Year: 2026

Type: article

Abstract: Background Infective endocarditis (IE) is a serious complication of Staphylococcus aureus bacteremia (SAB). Systematic echocardiographic evaluation, especially when including transesophageal echocardiography, is resource-intensive. Existing risk scores do not include S. aureus bacteriuria, a potential marker of hematogenous spread. We assessed whether bacteriuria improves IE risk stratification. Methods We retrospectively analyzed 2 temporally distinct cohorts of adult SAB patients in a French tertiary hospital: a derivation cohort (2012–2019, n = 233) and a validation cohort (2020–2023, n = 156). Patients with proven urinary tract infection were excluded. Logistic regression identified predictors of IE, which were converted into weighted points to develop 2 scores: day 1 (baseline variables) and day 4 (including persistent bacteremia ≥72 hours). Performance was compared with VIRSTA and PREDICT. Results Infective endocarditis occurred in 14.6% of the derivation cohort and 14.7% of the validation cohort. Independent predictors were intracardiac devices, community acquisition, bacteriuria, septic emboli, and persistent bacteremia. AUROCs for the day 1 and day 4 scores were 0.78 and 0.81 in derivation, and 0.91 and 0.93 in validation. At thresholds of >2 and >3, sensitivities were 67.65% and 70.59%, with negative predictive values of 93.29% and 93.83%, respectively. Compared with VIRSTA and PREDICT, BACT-URIE showed higher sensitivity in this cohort. Conclusions BACT-URIE is an exploratory score incorporating S. aureus bacteriuria to predict IE in SAB. Prospective multicenter validation is required before clinical implementation.

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofag259