What is the role of echocardiography in the diagnosis of enterococcal infections?

Updated: Jun 10, 2021
  • Author: Susan L Fraser, MD; Chief Editor: John L Brusch, MD, FACP  more...
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Answer

Echocardiography should be performed when enterococcal endocarditis is suggested.

Transthoracic echocardiography is often performed as an initial screening test; if endocarditis is strongly suggested and the transthoracic echocardiography findings are negative, transesophageal echocardiography should be performed.

In patients in whom multiple blood cultures are positive for enterococci, the decision of whether to perform transesophageal echocardiography is often challenging. The NOVA scoring system was developed as a decision-making aid by assigning points to the following:

  • More than 3 positive blood cultures: 5 points
  • Unknown origin of the bacteremia: 4 points
  • Underlying valvular heart disease: 2 points
  • Audible heart murmur: 1 point

A score of 4 or more had a sensitivity of 100% and a specificity of 29%. A score of less than 4 denoted a very low risk of endocarditis and would not require transesophageal echocardiography. [31]

In 2018 the DENOVA scoring system was proposed by Berge et al. [32] It added Duration of symptoms greater than or equal to 7 days, and presence of Embolization, and gave equal weight (1 point each) to all six parameters. If 3 or more points were calculated, the DENOVA score had higher specificity (83%) with equal sensitivity (100%) as the NOVA score to assist in determining the need for transesophageal echocardiography.


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