Clinical characteristics, risk factors, and outcome of Enterococcal bacteraemia: Assessment of the DENOVA score in a diverse patient cohort

BACKGROUND: Enterococcal bacteraemia is associated with high mortality rates ranging from 14% to 50% and is one of the most common causes of infective endocarditis. The DENOVA score is a validated screening tool for patients with monomicrobial E. faecalis bacteraemia who require echocardiography to rule out infective endocarditis. METHODS: Adult patients hospitalized at Hannover Medical School during the years of 2021 and 2022 with at least one paired blood culture positive for Enterococcus species were included in this retrospective observational study. Risk factors associated with in-hospital mortality were identified through a multivariable analysis using logistic regression. Clinical differences associated with the underlying pathogen were analysed. The performance of the DENOVA score for predicting infective endocarditis in enterococcal bacteraemia was evaluated in a high-risk cohort outside its validated application for monomicrobial E. faecalis bacteraemia. RESULTS: A total of 271 cases of enterococcal bacteraemia were included (65.7% E. faecium, 31.4% E. faecalis, 3% other enterococci). Patients with E. faecium bacteraemia had more vancomycin-resistant cases, longer hospital stays and a higher in-hospital mortality rate in comparison to E. faecalis bacteraemia. The Charlson Comorbidity Index, the Pitt Bacteraemia Score, and E. faecium bacteraemia were all factors independently associated with in-hospital mortality. 5% of enterococcal bacteraemia resulted in infective endocarditis (10.6% E. faecalis vs. 3.4% E. faecium). Applying the DENOVA score in our cohort let to a sensitivity of 86.7% and a specificity of 67.5% for predicting infective endocarditis. CONCLUSION: Enterococcal bacteraemia remains a clinical challenge with high morbidity and mortality. Our results suggest that the application of the DENOVA score might be possible in a high-risk cohort and even beyond its original validation. Future research should focus on personalized risk stratification and tailored management strategies to improve patient outcomes.