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VIRSTA score to determine priority for TEE in patients with Staphylococcus aureus bacteremia

VIRSTA score to determine priority for TEE in patients with Staphylococcus aureus bacteremia
Clinical condition Weight
Cerebral or peripheral emboli 5
Meningitis 5
Either of the following:
  • Permanent intracardiac device
  • Previous infective endocarditis
 4
Intravenous drug use 4
Pre-existing native valve disease 3
Persistent bacteremia* 3
Vertebral osteomyelitis 2
Community or non-nosocomial health care associated acquisition 2
Severe sepsis or shock 1
C-reactive protein >190 mg/L 1
The VIRSTA score was derived from a prospective cohort study including more than 2000 patients with S. aureus bacteremia to assess variables independently associated with endocarditis. TEE is warranted for patients with score ≥3; a score ≤2 had a negative predictive value of 98.8% (95% CI 98.4-99.4).

TEE: transesophageal echocardiography.

* Persistent bacteremia was defined as positive follow-up blood culture obtained 48 hours after initial positive blood culture.

Adapted from: Tubiana S, Duval X, Alla F, et al. The VIRSTA score, a prediction score to estimate risk of infective endocarditis and determine priority for echocardiography in patients with Staphylococcus aureus bacteremia. J Infect 2016; 75:544.
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