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Martin E. Stryjewski, G. Ralph Corey, Editorial Commentary: NOVA Score to Predict Endocarditis in Patients With Enterococcal Bacteremia: Sticking to Valves or to Scores?, Clinical Infectious Diseases, Volume 60, Issue 4, 15 February 2015, Pages 536–538, https://doi.org/10.1093/cid/ciu878
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(See the Major Article by Bouza et al on pages 528–35.)
Managing patients with enterococcal bacteremia or endocarditis is a significant challenge in clinical practice [1–6]. Studies indicate that 3%–9% of patients with enterococcal bacteremia have infective endocarditis [1–3]. Enterococcal endocarditis represents 10% of all cases of infective endocarditis, making it the third most common pathogen after staphylococci and streptococci [7]. Although several species have been described, Enterococcus faecalis is responsible for approximately 90% of cases of enterococcal endocarditis [8]. Given the changes in patient characteristics (eg, older, more comorbidities) and medical practice (eg, more invasive procedures, prolonged outpatient intravenous therapy), enterococci have also become an important cause of both healthcare-related and nosocomial endocarditis [9].
Evidence indicates that enterococcal bacteremia without endocarditis does not increase the risk of death when compared to similar patients without bacteremia [6]. In contrast, mortality in patients with enterococcal endocarditis is high, reaching 29% at 1 year for all patients and 39% for patients with prosthetic valves [8]. Patients with uncomplicated enterococcal bacteremia are usually treated for ≤2 weeks; however, patients with enterococcal endocarditis require longer and more complex treatments [10], particularly those patients infected with vancomycin-resistant enterococci [11]. Therefore, differentiating patients with enterococcal bacteremia from those with enterococcal endocarditis has critical implications in both the treatment and prognosis of such patients.
