{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T12:59:11Z","timestamp":1790168351844,"version":"4.1.0"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Medizinische Hochschule Hannover (MHH)"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infection"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      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\n                      <jats:italic>E. faecalis<\/jats:italic>\n                      bacteraemia who require echocardiography to rule out infective endocarditis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Adult patients hospitalized at Hannover Medical School during the years of 2021 and 2022 with at least one paired blood culture positive for\n                      <jats:italic>Enterococcus<\/jats:italic>\n                      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\n                      <jats:italic>E. faecalis<\/jats:italic>\n                      bacteraemia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 271 cases of enterococcal bacteraemia were included (65.7%\n                      <jats:italic>E. faecium<\/jats:italic>\n                      , 31.4%\n                      <jats:italic>E. faecalis<\/jats:italic>\n                      , 3% other enterococci). Patients with\n                      <jats:italic>E. faecium<\/jats:italic>\n                      bacteraemia had more vancomycin-resistant cases, longer hospital stays and a higher in-hospital mortality rate in comparison to\n                      <jats:italic>E. faecalis<\/jats:italic>\n                      bacteraemia. The Charlson Comorbidity Index, the Pitt Bacteraemia Score, and\n                      <jats:italic>E. faecium<\/jats:italic>\n                      bacteraemia were all factors independently associated with in-hospital mortality. 5% of enterococcal bacteraemia resulted in infective endocarditis (10.6%\n                      <jats:italic>E. faecalis<\/jats:italic>\n                      vs. 3.4%\n                      <jats:italic>E. faecium<\/jats:italic>\n                      ). Applying the DENOVA score in our cohort let to a sensitivity of 86.7% and a specificity of 67.5% for predicting infective endocarditis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s15010-026-02856-1","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T07:51:39Z","timestamp":1781682699000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical characteristics, risk factors, and outcome of Enterococcal bacteraemia: Assessment of the DENOVA score in a diverse patient cohort"],"prefix":"10.1007","author":[{"given":"Pia","family":"Wehage","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Fuge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Hilberink","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf-Peter","family":"Vonberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liz","family":"Kinast","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Simon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oana","family":"Joean","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Rademacher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"issue":"Pt 6","key":"2856_CR1","doi-asserted-by":"publisher","first-page":"1749","DOI":"10.1099\/mic.0.026385-0","volume":"155","author":"K Fisher","year":"2009","unstructured":"Fisher K, Phillips C. The ecology, epidemiology and virulence of Enterococcus. Microbiol (Reading). 2009;155(Pt 6):1749\u201357.","journal-title":"Microbiol (Reading)"},{"key":"2856_CR2","doi-asserted-by":"crossref","unstructured":"Kramer TS, Remschmidt C, Werner S, Behnke M, Schwab F, Werner G et al. The importance of adjusting for enterococcus species when assessing the burden of vancomycin resistance: A cohort study including over 1000 cases of enterococcal bloodstream infections. Antimicrob Resist Infect Control 2018-11-14;7(1).","DOI":"10.1186\/s13756-018-0419-9"},{"key":"2856_CR3","doi-asserted-by":"crossref","unstructured":"Ayobami O, Willrich N, Reuss A, Eckmanns T, Markwart R. The ongoing challenge of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis in Europe: An epidemiological analysis of bloodstream infections. Emerg Microbes Infect;9(1):1180\u201393.","DOI":"10.1080\/22221751.2020.1769500"},{"issue":"5","key":"2856_CR4","doi-asserted-by":"publisher","first-page":"1995","DOI":"10.1007\/s15010-024-02249-2","volume":"52","author":"D Hornuss","year":"2024","unstructured":"Hornuss D, G\u00f6pel S, Walker SV, Tobys D, H\u00e4cker G, Seifert H, et al. Epidemiological trends and susceptibility patterns of bloodstream infections caused by Enterococcus spp. in six German university hospitals: a prospectively evaluated multicentre cohort study from 2016 to 2020 of the R-Net study group. Infection. 2024;52(5):1995\u20132004.","journal-title":"Infection"},{"issue":"3","key":"2856_CR5","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1016\/j.cmi.2020.10.029","volume":"27","author":"E Del Rosselli","year":"2021","unstructured":"Del Rosselli E, Bartoletti M, Dahl A, Cervera C, Peric\u00e0s JM. How do I manage a patient with enterococcal bacteraemia? Clin Microbiol Infect. 2021;27(3):364\u201371.","journal-title":"Clin Microbiol Infect"},{"issue":"10","key":"2856_CR6","doi-asserted-by":"publisher","first-page":"2011","DOI":"10.1007\/s10096-024-04917-5","volume":"43","author":"F Scharloo","year":"2024","unstructured":"Scharloo F, Cogliati Dezza F, L\u00f3pez-Hern\u00e1ndez I, Mart\u00ednez P\u00e9rez-Crespo PM, Goikoetxea Aguirre AJ, P\u00e9rez-Rodr\u00edguez MT, et al. Clinical characteristics, predisposing factors and outcomes for Enterococcus faecalis versus Enterococcus faecium bloodstream infections: A prospective multicentre cohort study. Eur J Clin Microbiol Infect Dis. 2024;43(10):2011\u201322.","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2856_CR7","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.ijid.2014.02.012","volume":"26","author":"EO Billington","year":"2014","unstructured":"Billington EO, Phang SH, Gregson DB, Pitout JDD, Ross T, Church DL, et al. Incidence, risk factors, and outcomes for Enterococcus spp. blood stream infections: a population-based study. Int J Infect Dis. 2014;26:76\u201382.","journal-title":"Int J Infect Dis"},{"key":"2856_CR8","doi-asserted-by":"crossref","unstructured":"Brinkwirth S, Ayobami O, Eckmanns T, Markwart R. Hospital-acquired infections caused by Enterococci: A systematic review and meta-analysis, WHO European Region, 1 January 2010 to 4 February 2020. Euro Surveill 2021 November 11;26(45):2001628.","DOI":"10.2807\/1560-7917.ES.2021.26.45.2001628"},{"issue":"2","key":"2856_CR9","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1111\/1469-0691.12236","volume":"20","author":"M Pinholt","year":"2014","unstructured":"Pinholt M, Ostergaard C, Arpi M, Bruun NE, Sch\u00f8nheyder HC, Gradel KO, et al. Incidence, clinical characteristics and 30-day mortality of enterococcal bacteraemia in Denmark 2006\u20132009: a population-based cohort study. Clin Microbiol Infect. 2014;20(2):145\u201351.","journal-title":"Clin Microbiol Infect"},{"issue":"3","key":"2856_CR10","doi-asserted-by":"publisher","first-page":"ofaa064","DOI":"10.1093\/ofid\/ofaa064","volume":"7","author":"RA Lee","year":"2020","unstructured":"Lee RA, Vo DT, Zurko JC, Griffin RL, Rodriguez JM, Camins BC. Infectious diseases consultation is associated with decreased mortality in Enterococcal bloodstream infections. Open Forum Infect Dis. 2020;7(3):ofaa064.","journal-title":"Open Forum Infect Dis"},{"key":"2856_CR11","doi-asserted-by":"crossref","unstructured":"Suppli M, Aabenhus R, Harboe ZB, Andersen LP, Tvede M, Jensen J-S. Mortality in enterococcal bloodstream infections increases with inappropriate antimicrobial therapy. Clinical Microbiology and Infection 2011 July 1;17(7):1078\u20131083.","DOI":"10.1111\/j.1469-0691.2010.03394.x"},{"key":"2856_CR12","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.ijid.2023.04.411","volume":"134","author":"K Huh","year":"2023","unstructured":"Huh K, Chung DR, Ha YE, Ko J, Huh HJ, Lee NY, et al. Impact of vancomycin resistance in Enterococcus faecium bloodstream infection on mortality: A retrospective analysis of nationwide surveillance data. Int J Infect Dis. 2023;134:8\u201314.","journal-title":"Int J Infect Dis"},{"issue":"12","key":"2856_CR13","doi-asserted-by":"publisher","first-page":"1140","DOI":"10.1111\/1469-0691.12166","volume":"19","author":"C Chirouze","year":"2013","unstructured":"Chirouze C, Athan E, Alla F, Chu VH, Ralph Corey G, Selton-Suty C, et al. Enterococcal endocarditis in the beginning of the 21st century: Analysis from the International Collaboration on Endocarditis-Prospective Cohort Study. Clin Microbiol Infect. 2013;19(12):1140\u20137.","journal-title":"Clin Microbiol Infect"},{"issue":"4","key":"2856_CR14","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1093\/cid\/ciu872","volume":"60","author":"E Bouza","year":"2015","unstructured":"Bouza E, Kestler M, Beca T, Mariscal G, Rodr\u00edguez-Cr\u00e9ixems M, Bermejo J, et al. The NOVA score: A proposal to reduce the need for transesophageal echocardiography in patients with enterococcal bacteremia. Clin Infect Dis. 2015;60(4):528\u201335.","journal-title":"Clin Infect Dis"},{"issue":"6","key":"2856_CR15","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1093\/cid\/ciw383","volume":"63","author":"A Dahl","year":"2016","unstructured":"Dahl A, Lauridsen TK, Arpi M, S\u00f8rensen LL, \u00d8stergaard C, Sogaard P, et al. Risk factors of endocarditis in patients with Enterococcus faecalis bacteremia: External validation of the NOVA score. Clin Infect Dis. 2016;63(6):771\u20135.","journal-title":"Clin Infect Dis"},{"issue":"1","key":"2856_CR16","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1007\/s15010-018-1208-3","volume":"47","author":"A Berge","year":"2019","unstructured":"Berge A, Krantz A, \u00d6stlund H, Naucl\u00e9r P, Rasmussen M. The DENOVA score efficiently identifies patients with monomicrobial Enterococcus faecalis bacteremia where echocardiography is not necessary. Infection. 2019;47(1):45\u201350.","journal-title":"Infection"},{"issue":"6","key":"2856_CR17","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1016\/j.jinf.2023.09.001","volume":"87","author":"P Danneels","year":"2023","unstructured":"Danneels P, Chabrun F, Picard L, Martinet P, Rezig S, Lorleac\u2019h A, et al. Enterococcus faecalis endocarditis risk assessment in patients with bacteremia: External validation of the DENOVA score. J Infect. 2023;87(6):571\u20133.","journal-title":"J Infect"},{"issue":"2","key":"2856_CR18","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1080\/003655498750003546","volume":"30","author":"JP Suppola","year":"1998","unstructured":"Suppola JP, Kuikka A, Vaara M, Valtonen VV. Comparison of risk factors and outcome in patients with Enterococcus faecalis vs Enterococcus faecium bacteraemia. Scand J Infect Dis. 1998;30(2):153\u20137.","journal-title":"Scand J Infect Dis"},{"issue":"17","key":"2856_CR19","first-page":"818","volume":"85","author":"JS Garner","year":"1991","unstructured":"Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections 1988. Z Arztl Fortbild (Jena). 1991;85(17):818\u201327.","journal-title":"Z Arztl Fortbild (Jena)"},{"key":"2856_CR20","doi-asserted-by":"crossref","unstructured":"Paterson DL, Ko W, Von Gottberg A, Mohapatra S, Casellas JM, Goossens H, et al. International prospective study of Klebsiella pneumoniae bacteremia: implications of extended-spectrum beta-lactamase production in nosocomial Infections. Ann Intern Med. 2004-01-06;140(1):26\u201332.","DOI":"10.7326\/0003-4819-140-1-200401060-00008"},{"issue":"4","key":"2856_CR21","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1086\/313753","volume":"30","author":"JS Li","year":"2000","unstructured":"Li JS, Sexton DJ, Mick N, Nettles R, Fowler VGJ, Ryan T, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30(4):633\u20138.","journal-title":"Clin Infect Dis"},{"issue":"5","key":"2856_CR22","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","volume":"40","author":"ME Charlson","year":"1987","unstructured":"Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373\u201383.","journal-title":"J Chronic Dis"},{"issue":"6","key":"2856_CR23","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1093\/aje\/kwq433","volume":"173","author":"H Quan","year":"2011","unstructured":"Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173(6):676\u201382.","journal-title":"Am J Epidemiol"},{"key":"2856_CR24","doi-asserted-by":"crossref","unstructured":"Rockwood K, Theou O. Using the clinical frailty scale in allocating scarce health care resources. Can Geriatr J 2020 -09;23(3):210\u20135.","DOI":"10.5770\/cgj.23.463"},{"issue":"4","key":"2856_CR25","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.1007\/s11739-022-02926-w","volume":"17","author":"T Lupia","year":"2022","unstructured":"Lupia T, Roberto G, Scaglione L, Shbaklo N, De Benedetto I, Scabini S, et al. Clinical and microbiological characteristics of bloodstream infections caused by Enterococcus spp. within internal medicine wards: a two-year single-centre experience. Intern Emerg Med. 2022;17(4):1129\u201337.","journal-title":"Intern Emerg Med"},{"key":"2856_CR26","doi-asserted-by":"crossref","unstructured":"Bartoletti M, Tedeschi S, Scudeller L, Pascale R, Del Turco ER, Trapani F et al. Impact on mortality of a bundle for the management of Enterococcal bloodstream infection. Open Forum Infect Dis 2019-11\u201304.","DOI":"10.1093\/ofid\/ofz473"},{"key":"2856_CR27","first-page":"104258","volume":"80","author":"GA Ali","year":"2022","unstructured":"Ali GA, Goravey W, Najim MS, Shunnar KM, Ibrahim SI, Daghfal J, et al. Epidemiology, microbiological and clinical characteristics of Enterococcus species bloodstream infections: A 10-year retrospective cohort study from Qatar. Ann Med Surg (Lond). 2022;80:104258.","journal-title":"Ann Med Surg (Lond)"},{"issue":"4","key":"2856_CR28","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1089\/mdr.2020.0147","volume":"27","author":"J Monticelli","year":"2021","unstructured":"Monticelli J, Di Bella S, Giacobbe DR, Amato G, Antonello RM, Barone E, et al. Trends in the Incidence and Antibiotic Resistance of Enterococcal Bloodstream Isolates: A 7-Year Retrospective Multicenter Epidemiological Study in Italy. Microb Drug Resist. 2021;27(4):529\u201335.","journal-title":"Microb Drug Resist"},{"key":"2856_CR29","doi-asserted-by":"crossref","unstructured":"R\u00f6denbeck M, Ayobami O, Eckmanns T, Pletz MW, Bleidorn J, Markwart R. Clinical epidemiology and case fatality due to antimicrobial resistance in Germany: a systematic review and meta-analysis, 1 January 2010 to 31 December 2021. Euro Surveill 2023 -05;28(20):2200672.","DOI":"10.2807\/1560-7917.ES.2023.28.20.2200672"},{"issue":"10","key":"2856_CR30","doi-asserted-by":"publisher","first-page":"1932","DOI":"10.3390\/microorganisms12101932","volume":"12","author":"E S\u00f6rstedt","year":"2024","unstructured":"S\u00f6rstedt E, Ahlbeck G, Snygg-Martin U. Trends in Enterococcus faecium Bacteremia: Exploring Risk Factors with Emphasis on Prior Antibiotic Exposure. Microorganisms. 2024;12(10):1932. https:\/\/doi.org\/10.3390\/microorganisms12101932.","journal-title":"Microorganisms"},{"issue":"2","key":"2856_CR31","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/j.jacc.2019.04.059","volume":"74","author":"A Dahl","year":"2019","unstructured":"Dahl A, Iversen K, Tonder N, Hoest N, Arpi M, Dalsgaard M, et al. Prevalence of Infective Endocarditis in Enterococcus faecalis Bacteremia. J Am Coll Cardiol. 2019;74(2):193\u2013201.","journal-title":"J Am Coll Cardiol"},{"key":"2856_CR32","doi-asserted-by":"publisher","first-page":"100336","DOI":"10.1016\/j.clinpr.2023.100336","volume":"21","author":"C Nye","year":"2024","unstructured":"Nye C, Maxwell A, Hughes H, Underwood J. Enterococcus faecalis bacteraemia and infective endocarditis - what are we missing? Clin Infect Pract. 2024;21:100336.","journal-title":"Clin Infect Pract"},{"issue":"39","key":"2856_CR33","doi-asserted-by":"publisher","first-page":"3237","DOI":"10.1093\/eurheartj\/ehz327","volume":"40","author":"L \u00d8stergaard","year":"2019","unstructured":"\u00d8stergaard L, Bruun NE, Voldstedlund M, Arpi M, Andersen C\u00d8, Sch\u00f8nheyder HC, et al. Prevalence of infective endocarditis in patients with positive blood cultures: a Danish nationwide study. Eur Heart J. 2019;40(39):3237\u201344.","journal-title":"Eur Heart J"},{"issue":"3","key":"2856_CR34","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1016\/j.cmi.2023.08.027","volume":"30","author":"M Rasmussen","year":"2024","unstructured":"Rasmussen M, Gilje P, Fagman E, Berge A. Bacteraemia with gram-positive bacteria-when and how do I need to look for endocarditis? Clin Microbiol Infect. 2024;30(3):306\u201311.","journal-title":"Clin Microbiol Infect"}],"container-title":["Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s15010-026-02856-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s15010-026-02856-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s15010-026-02856-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T07:51:53Z","timestamp":1781682713000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s15010-026-02856-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,17]]},"references-count":34,"alternative-id":["2856"],"URL":"https:\/\/doi.org\/10.1007\/s15010-026-02856-1","relation":{},"ISSN":["0300-8126","1439-0973"],"issn-type":[{"value":"0300-8126","type":"print"},{"value":"1439-0973","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,17]]},"assertion":[{"value":"4 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}