{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T20:52:31Z","timestamp":1788900751816,"version":"build-2803163510"},"reference-count":35,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Few bedside tools with defined accuracy have been described that are useful to alter bayesian prior probability for infective endocarditis (IE) in patients with bacteremia.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the accuracy of simple blood culture parameters to guide pretest probability of IE.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This multicenter, retrospective case-control study of blood culture data in adults with IE vs without IE was conducted at 3 acute care public hospitals in the Los Angeles County Department of Health Services between December 2018 and August 2022. Patients were individuals aged 18 years or older who had positive blood cultures and met the inclusion criteria, including cases who met the Duke criteria for definite or possible IE, and control cases who did not have concern for endocarditis.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n \n Positive blood cultures for methicillin-susceptible\n Staphylococcus aureus<\/jats:italic>\n , methicillin-resistant\n S aureus<\/jats:italic>\n ,\n Enterococcus faecalis<\/jats:italic>\n , low-risk\n Streptococcus<\/jats:italic>\n species, or high-risk\n Streptococcus<\/jats:italic>\n species.\n <\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was the negative likelihood ratio (LR) of having endocarditis based on the number of positive blood cultures on admission. Positive LRs, evaluation of 2 or more of 4 bottles positive on admission, bacteremia lasting for at least 2 days, and combination groups were secondary outcomes.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 252 eligible patients with IE (182 male [72%]; median [IQR] age, 54 [38-65] years), including 164 definite and 88 possible IE cases, and 455 controls (321 male [71%]; median [IQR] age, 53 [41-63] years) were identified. The negative LR point estimates for having IE with only 1 of 4 positive blood culture bottles on admission ranged from 0.05 (95% CI, 0.01-0.37) for\n E faecalis<\/jats:italic>\n to 0.12 (95% CI, 0.03-0.49) for methicillin-susceptible\n S aureus<\/jats:italic>\n . Sensitivity analysis of cases restricted to definite IE found similar results. Blood culture clearance by day 2 also had modestly helpful negative LRs for methicillin-resistant\n S aureus<\/jats:italic>\n (0.24; 95% CI, 0.13-0.42) and\n Enterococcus<\/jats:italic>\n species (0.34; 95% CI, 0.21-0.56). If patients had 4 of 4 bottles positive on admission, positive LRs were helpful for\n Enterococcus<\/jats:italic>\n species (LR, 4.21; 95% CI, 2.53-7.02) and high-risk streptococci (LR, 5.35; 95% CI, 3.39-8.42) and for all organisms with persistent bacteremia (with LRs ranging from 1.78 [95% CI, 1.36-2.34] to 9.60 [95% CI, 3.43-44.60]). If both were true, the positive LRs ranged from 1.63 (95% CI, 1.17-2.28) to 8.59 (95% CI, 3.43-21.55) for all organisms.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this case-control study of patients with and without IE, the number of initial positive blood culture bottles and days to culture clearance were helpful to adjust pretest probability of IE. These findings may help guide diagnostic and therapeutic decisions around bacteremia early during hospitalization.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.8079","type":"journal-article","created":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T11:30:57Z","timestamp":1746099057000},"page":"e258079","source":"Crossref","is-referenced-by-count":5,"title":["Interpreting Blood Culture Results as Early Guidance for Infective Endocarditis"],"prefix":"10.1001","volume":"8","author":[{"given":"Sarah R.","family":"Freling","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Los Angeles General Medical Center, Los Angeles, California"},{"name":"Department of Medicine, Keck School of Medicine of USC, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iman","family":"Richie","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Los Angeles General Medical Center, Los Angeles, California"},{"name":"Department of Medicine, Keck School of Medicine of USC, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Norwitz","sequence":"additional","affiliation":[{"name":"Department of Population Public Health Sciences, Keck School of Medicine of USC, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine P.","family":"Canamar","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Los Angeles General Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josh","family":"Banerjee","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Los Angeles General Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kusha","family":"Davar","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Los Angeles General Medical Center, Los Angeles, California"},{"name":"Department of Medicine, Keck School of Medicine of USC, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devin","family":"Clark","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Los Angeles General Medical Center, Los Angeles, California"},{"name":"Department of Medicine, Keck School of Medicine of USC, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brad","family":"Spellberg","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Los Angeles General Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,5,1]]},"reference":[{"issue":"1","key":"zoi250297r1","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1093\/cid\/ciae187","article-title":"Low-risk Staphylococcus aureus bacteremia patients do not require routine diagnostic imaging: a multicenter retrospective cohort study.","volume":"79","author":"Hendriks","year":"2024","journal-title":"Clin Infect Dis"},{"issue":"23","key":"zoi250297r2","doi-asserted-by":"publisher","first-page":"1749","DOI":"10.1093\/eurheartj\/ehs379","article-title":"Prognostic role of persistent positive blood cultures after initiation of antibiotic therapy in left-sided infective endocarditis.","volume":"34","author":"L\u00f3pez","year":"2013","journal-title":"Eur Heart J"},{"issue":"1","key":"zoi250297r3","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.jinf.2022.10.042","article-title":"Redefining Staphylococcus aureus bacteremia: a structured approach guiding diagnostic and therapeutic management.","volume":"86","author":"Kouijzer","year":"2023","journal-title":"J Infect"},{"issue":"7","key":"zoi250297r4","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.26366","article-title":"Guidelines for diagnosis and management of infective endocarditis in adults: a WikiGuidelines Group Consensus Statement.","volume":"6","author":"McDonald","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"12","key":"zoi250297r5","doi-asserted-by":"publisher","first-page":"1724","DOI":"10.1086\/421087","article-title":"Optimal testing parameters for blood cultures.","volume":"38","author":"Cockerill","year":"2004","journal-title":"Clin Infect Dis"},{"issue":"11","key":"zoi250297r6","doi-asserted-by":"publisher","first-page":"3546","DOI":"10.1128\/JCM.01555-07","article-title":"Detection of bloodstream infections in adults: how many blood cultures are needed?","volume":"45","author":"Lee","year":"2007","journal-title":"J Clin Microbiol"},{"issue":"8","key":"zoi250297r7","doi-asserted-by":"publisher","first-page":"547","DOI":"10.7326\/M19-1696","article-title":"Blood culture results before and after antimicrobial administration in patients with severe manifestations of sepsis: a diagnostic study.","volume":"171","author":"Cheng","year":"2019","journal-title":"Ann Intern Med"},{"issue":"2","key":"zoi250297r8","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofab642","article-title":"Clinical significance of Staphylococcus aureus in a single positive blood culture bottle.","volume":"9","author":"Go","year":"2021","journal-title":"Open Forum Infect Dis"},{"issue":"2","key":"zoi250297r9","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/j.jacc.2019.04.059","article-title":"Prevalence of infective endocarditis in Enterococcus faecalis bacteremia.","volume":"74","author":"Dahl","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"zoi250297r10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2024.107022","article-title":"Association of persistent positive blood cultures and infective endocarditis: a cohort study among patients with suspected infective endocarditis.","volume":"143","author":"Teixeira Antunes","year":"2024","journal-title":"Int J Infect Dis"},{"issue":"12","key":"zoi250297r11","doi-asserted-by":"publisher","first-page":"900","DOI":"10.1016\/j.cmi.2017.04.025","article-title":"Clinical predictors and clinical prediction rules to estimate initial patient risk for infective endocarditis in Staphylococcus aureus bacteraemia: a systematic review and meta-analysis.","volume":"23","author":"Bai","year":"2017","journal-title":"Clin Microbiol Infect"},{"issue":"7","key":"zoi250297r12","doi-asserted-by":"publisher","first-page":"e1745","DOI":"10.1093\/cid\/ciaa844","article-title":"Prospective validation of PREDICT and its impact on the transesophageal echocardiography use in management of Staphylococcus aureus bacteremia.","volume":"73","author":"Abu Saleh","year":"2021","journal-title":"Clin Infect Dis"},{"issue":"1","key":"zoi250297r13","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1093\/cid\/civ235","article-title":"Predicting Risk of Endocarditis Using a Clinical Tool (PREDICT): scoring system to guide use of echocardiography in the management of Staphylococcus aureus bacteremia.","volume":"61","author":"Palraj","year":"2015","journal-title":"Clin Infect Dis"},{"issue":"5","key":"zoi250297r14","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1016\/j.jinf.2016.02.003","article-title":"The VIRSTA score, a prediction score to estimate risk of infective endocarditis and determine priority for echocardiography in patients with Staphylococcus aureus bacteremia.","volume":"72","author":"Tubiana","year":"2016","journal-title":"J Infect"},{"issue":"5","key":"zoi250297r15","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1016\/j.cmi.2022.01.010","article-title":"Time to blood culture positivity in Staphylococcus aureus bacteraemia to determine risk of infective endocarditis: authors\u2019 reply.","volume":"28","author":"Kahn","year":"2022","journal-title":"Clin Microbiol Infect"},{"issue":"3","key":"zoi250297r16","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1093\/infdis\/jiae080","article-title":"A machine learning-based risk score for prediction of infective endocarditis among patients with Staphylococcus aureus bacteraemia: the SABIER score.","volume":"230","author":"Lai","year":"2024","journal-title":"J Infect Dis"},{"issue":"1","key":"zoi250297r17","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1007\/s15010-018-1208-3","article-title":"The DENOVA score efficiently identifies patients with monomicrobial Enterococcus faecalis bacteremia where echocardiography is not necessary.","volume":"47","author":"Berge","year":"2019","journal-title":"Infection"},{"issue":"4","key":"zoi250297r18","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1093\/cid\/ciu872","article-title":"The NOVA score: a proposal to reduce the need for transesophageal echocardiography in patients with enterococcal bacteremia.","volume":"60","author":"Bouza","year":"2015","journal-title":"Clin Infect Dis"},{"issue":"5","key":"zoi250297r19","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1093\/cid\/cix880","article-title":"HANDOC: a handy score to determine the need for echocardiography in non-\u00df-hemolytic streptococcal bacteremia.","volume":"66","author":"Sunnerhagen","year":"2018","journal-title":"Clin Infect Dis"},{"issue":"4","key":"zoi250297r20","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"61","author":"von Elm","year":"2008","journal-title":"J Clin Epidemiol"},{"issue":"5","key":"zoi250297r21","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1093\/cid\/ciad119","article-title":"Real-world application of oral therapy for infective endocarditis: a multicenter, retrospective, cohort study.","volume":"77","author":"Freling","year":"2023","journal-title":"Clin Infect Dis"},{"issue":"25","key":"zoi250297r22","doi-asserted-by":"publisher","first-page":"2936","DOI":"10.1161\/01.CIR.98.25.2936","article-title":"Diagnosis and management of infective endocarditis and its complications.","volume":"98","author":"Bayer","year":"1998","journal-title":"Circulation"},{"issue":"3","key":"zoi250297r23","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1016\/0002-9343(94)90144-9","article-title":"Evaluation of new clinical criteria for the diagnosis of infective endocarditis.","volume":"96","author":"Bayer","year":"1994","journal-title":"Am J Med"},{"issue":"4","key":"zoi250297r24","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1086\/313753","article-title":"Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis.","volume":"30","author":"Li","year":"2000","journal-title":"Clin Infect Dis"},{"issue":"4","key":"zoi250297r25","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1093\/cid\/ciad271","article-title":"The 2023 Duke-International Society for Cardiovascular Infectious Diseases criteria for infective endocarditis: updating the modified Duke criteria.","volume":"77","author":"Fowler","year":"2023","journal-title":"Clin Infect Dis"},{"issue":"3","key":"zoi250297r26","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1016\/j.cmi.2023.08.027","article-title":"Bacteraemia with gram-positive bacteria: when and how do I need to look for endocarditis?","volume":"30","author":"Rasmussen","year":"2024","journal-title":"Clin Microbiol Infect"},{"issue":"1","key":"zoi250297r27","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1186\/s12879-021-06391-2","article-title":"Proposal for the use of echocardiography in bloodstream infections due to different streptococcal species.","volume":"21","author":"Chamat-Hedemand","year":"2021","journal-title":"BMC Infect Dis"},{"issue":"2","key":"zoi250297r28","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1093\/cid\/ciae315","article-title":"Evaluation of the HANDOC score and the 2023 International Society of Cardiovascular Infectious Diseases and European Society of Cardiology Duke clinical criteria for the diagnosis of infective endocarditis among patients with streptococcal bacteremia.","volume":"79","author":"Fourre","year":"2024","journal-title":"Clin Infect Dis"},{"issue":"17","key":"zoi250297r30","doi-asserted-by":"publisher","first-page":"2066","DOI":"10.1001\/archinte.163.17.2066","article-title":"Clinical identifiers of complicated Staphylococcus aureus bacteremia.","volume":"163","author":"Fowler","year":"2003","journal-title":"Arch Intern Med"},{"issue":"12","key":"zoi250297r31","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofac647","article-title":"Prevalence and mortality of infective endocarditis in community-acquired and healthcare-associated Staphylococcus aureus bacteremia: a Danish nationwide registry-based cohort study.","volume":"9","author":"\u00d8stergaard","year":"2022","journal-title":"Open Forum Infect Dis"},{"issue":"7","key":"zoi250297r32","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofac200","article-title":"Impact of infectious diseases consultation on the outcome of patients with enterococcal bacteremia: a systematic literature review and meta-analysis.","volume":"9","author":"Tholany","year":"2022","journal-title":"Open Forum Infect Dis"},{"issue":"39","key":"zoi250297r33","doi-asserted-by":"publisher","first-page":"3237","DOI":"10.1093\/eurheartj\/ehz327","article-title":"Prevalence of infective endocarditis in patients with positive blood cultures: a Danish nationwide study.","volume":"40","author":"\u00d8stergaard","year":"2019","journal-title":"Eur Heart J"},{"issue":"8","key":"zoi250297r34","doi-asserted-by":"publisher","first-page":"1442","DOI":"10.1093\/cid\/ciab632","article-title":"Prediction rules for ruling out endocarditis in patients with Staphylococcus aureus bacteremia.","volume":"74","author":"van der Vaart","year":"2022","journal-title":"Clin Infect Dis"},{"issue":"15","key":"zoi250297r35","doi-asserted-by":"publisher","first-page":"1435","DOI":"10.1161\/CIR.0000000000000296","article-title":"Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association.","volume":"132","author":"Baddour","year":"2015","journal-title":"Circulation"},{"key":"zoi250297r29","volume-title":"Diagnostic Testing Accuracy: Sensitivity, Specificity, Predictive Values and Likelihood Ratios","author":"Shreffler","year":"2025"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2833356\/freling_2025_oi_250297_1745349646.68913.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T11:30:58Z","timestamp":1746099058000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2833356"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,1]]},"references-count":35,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.8079","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,1]]}}}