{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T12:59:40Z","timestamp":1790168380600,"version":"4.1.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T00:00:00Z","timestamp":1747008000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The 2023 Duke\u2013International Society for Cardiovascular Infectious Diseases (ISCVID) guideline included Enterococcus faecalis as a typical infective endocarditis (IE) organism irrespective of the primary source and setting of infection. Universal echocardiogram for E. faecalis bacteremia is resource-intensive. Our aim was to develop a risk score that can be applied at the time of bacteremia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a retrospective cohort study utilizing a territory-wide electronic database and included all inpatients (age \u226518) between 2009 and 2019 who had at least 1 blood culture positive for E. faecalis. A multistep machine learning algorithm was employed to generate the risk score.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 2535 distinct E. faecalis bacteremia episodes were analyzed. The percentage of IE was 3.39% (86\/2535). The Machine Learning\u2013derived Enterococcus faecalis Infective Endocarditis Risk (MEFIER) score was developed based on history of valvular heart disease (28 points), history of congenital heart disease (14 points), presence of cardiac implantable electronic device (12 points), age (\u226518 to &amp;lt;43 years: 3 points; \u226543 to &amp;lt;65 years: 6 points), male gender (2 points), community onset (11 points), and abnormal levels of hemoglobin (16 points), albumin (3 points), and platelets (1 point). With a threshold of \u226532 indicating high risk for IE, the MEFIER score demonstrated an area under the receiver operating characteristic curve of 0.79 (95% CI, 0.72\u20130.88) and a negative predictive value of 0.98 (95% CI, 0.97\u20130.99).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The MEFIER score is a unique tool to stratify IE patients with E. faecalis bacteremia, boasting a negative predictive value of 98%, to guide use of echocardiography in these patients.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofaf287","type":"journal-article","created":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T11:39:14Z","timestamp":1747049954000},"source":"Crossref","is-referenced-by-count":4,"title":["The MEFIER Score\u2014A Risk Score to Stratify Infective Endocarditis in Patients With <i>Enterococcus faecalis<\/i> Bacteremia Based on an 11-Year Territory-Wide Cohort"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8591-5944","authenticated-orcid":false,"given":"Christopher K C","family":"Lai","sequence":"first","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong , Hong Kong SAR ,","place":["China"]},{"name":"S.H. Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong , Hong Kong SAR ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8267-1785","authenticated-orcid":false,"given":"Eman","family":"Leung","sequence":"additional","affiliation":[{"name":"School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong , Hong Kong SAR ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred L H","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Prince of Wales Hospital, Hospital Authority , Hong Kong SAR ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinze","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Computer Science and Engineering, Faculty of Engineering, The Chinese University of Hong Kong , Hong Kong SAR ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinan","family":"He","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong , Hong Kong SAR ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Computer Science and Engineering, Faculty of Engineering, The Chinese University of Hong Kong , Hong Kong SAR ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross K K","family":"Leung","sequence":"additional","affiliation":[{"name":"S.H. Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong , Hong Kong SAR ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace C Y","family":"Lui","sequence":"additional","affiliation":[{"name":"Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong , Hong Kong SAR ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1819-2464","authenticated-orcid":false,"given":"Terry C F","family":"Yip","sequence":"additional","affiliation":[{"name":"Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong , Hong Kong SAR ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace L H","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong , Hong Kong SAR ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex P W","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong , Hong Kong SAR ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randolph H L","family":"Wong","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong , Hong Kong SAR ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1291-6537","authenticated-orcid":false,"given":"Margaret","family":"Ip","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong , Hong Kong SAR ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,5,12]]},"reference":[{"key":"2025062505201741900_ofaf287-B1","doi-asserted-by":"crossref","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":"2025062505201741900_ofaf287-B2","doi-asserted-by":"crossref","first-page":"349","DOI":"10.2217\/fmb-2019-0247","article-title":"Enterococcus faecalis endocarditis: what's next?","volume":"15","author":"Fern\u00e1ndez-Hidalgo","year":"2020","journal-title":"Future Microbiol"},{"key":"2025062505201741900_ofaf287-B3","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.jcin.2014.09.013","article-title":"Prosthetic valve endocarditis after transcatheter valve replacement: a systematic review","volume":"8","author":"Amat-Santos","year":"2015","journal-title":"JACC Cardiovasc Interv"},{"key":"2025062505201741900_ofaf287-B4","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1093\/eurheartj\/ehl427","article-title":"Infective endocarditis: changing epidemiology and predictors of 6-month mortality: a prospective cohort study","volume":"28","author":"Hill","year":"2007","journal-title":"Eur Heart J"},{"key":"2025062505201741900_ofaf287-B5","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1093\/eurheartj\/eht274","article-title":"Cardiac imaging in infectious endocarditis","volume":"35","author":"Bruun","year":"2014","journal-title":"Eur Heart J"},{"key":"2025062505201741900_ofaf287-B6","doi-asserted-by":"crossref","first-page":"2795","DOI":"10.1016\/j.jacc.2017.10.005","article-title":"The evolving nature of infective endocarditis in Spain: a population-based study (2003 to 2014)","volume":"70","author":"Olmos","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"2025062505201741900_ofaf287-B7","doi-asserted-by":"crossref","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"},{"key":"2025062505201741900_ofaf287-B8","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.jacc.2019.03.526","article-title":"Enterococcus faecalis bacteremia: consider an echocardiography, but consult an infectious diseases specialist","volume":"74","author":"Fern\u00e1ndez-Hidalgo","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2025062505201741900_ofaf287-B9","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1007\/s10096-020-04117-x","article-title":"Secular trends in the epidemiology and clinical characteristics of Enterococcus faecalis infective endocarditis at a referral center (2007\u20132018)","volume":"40","author":"Escol\u00e0-Verg\u00e9","year":"2021","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2025062505201741900_ofaf287-B10","doi-asserted-by":"crossref","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"},{"key":"2025062505201741900_ofaf287-B11","doi-asserted-by":"crossref","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"},{"key":"2025062505201741900_ofaf287-B12","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1093\/cid\/ciw383","article-title":"Risk factors of endocarditis in patients with Enterococcus faecalis bacteremia: external validation of the NOVA score","volume":"63","author":"Dahl","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2025062505201741900_ofaf287-B13","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/j.jinf.2023.09.001","article-title":"Enterococcus faecalis endocarditis risk assessment in patients with bacteremia: external validation of the DENOVA score","volume":"87","author":"Danneels","year":"2023","journal-title":"J Infect"},{"key":"2025062505201741900_ofaf287-B14","doi-asserted-by":"crossref","first-page":"e21798","DOI":"10.2196\/21798","article-title":"AutoScore: a machine learning-based automatic clinical score generator and its application to mortality prediction using electronic health records","volume":"8","author":"Xie","year":"2020","journal-title":"JMIR Med Inform"},{"key":"2025062505201741900_ofaf287-B15","doi-asserted-by":"crossref","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\u2014the SABIER score","volume":"230","author":"Lai","year":"2024","journal-title":"J Infect Dis"},{"key":"2025062505201741900_ofaf287-B16","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s12874-022-01824-1","article-title":"A hybrid machine learning framework to improve prediction of all-cause rehospitalization among elderly patients in Hong Kong","volume":"23","author":"Guan","year":"2023","journal-title":"BMC Med Res Methodol"},{"key":"2025062505201741900_ofaf287-B17","doi-asserted-by":"crossref","DOI":"10.1002\/9781118548387","volume-title":"Applied Logistic Regression","author":"Hosmer","year":"2013"},{"key":"2025062505201741900_ofaf287-B18","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1111\/1469-0691.12166","article-title":"Enterococcal endocarditis in the beginning of the 21st century: analysis from the International Collaboration on Endocarditis-prospective cohort study","volume":"19","author":"Chirouze","year":"2013","journal-title":"Clin Microbiol Infect"},{"key":"2025062505201741900_ofaf287-B19","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1016\/j.amjmed.2005.02.020","article-title":"Enterococcal endocarditis: 107 cases from the International Collaboration on Endocarditis merged database","volume":"118","author":"McDonald","year":"2005","journal-title":"Am J Med"},{"key":"2025062505201741900_ofaf287-B20","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/j.eimc.2009.02.007","article-title":"Enterococcal endocarditis: a multicenter study of 76 cases [in Spanish]","volume":"27","author":"Mart\u00ednez-Marcos","year":"2009","journal-title":"Enferm Infecc Microbiol Clin"},{"key":"2025062505201741900_ofaf287-B21","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.ijcard.2022.04.078","article-title":"Epidemiology and management of Staphylococcus aureus infective endocarditis in adult patients with congenital heart disease: a single tertiary center experience","volume":"360","author":"Arvanitaki","year":"2022","journal-title":"Int J Cardiol"},{"key":"2025062505201741900_ofaf287-B22","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1007\/s10096-023-04585-x","article-title":"Staphylococcus aureus bacteraemia, cardiac implantable electronic device, and the risk of endocarditis: a retrospective population-based cohort study","volume":"42","author":"Berge","year":"2023","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2025062505201741900_ofaf287-B23","doi-asserted-by":"crossref","first-page":"e7913","DOI":"10.1097\/MD.0000000000007913","article-title":"Infective endocarditis in patients with cancer: a consequence of invasive procedures or a harbinger of neoplasm? A prospective, multicenter cohort","volume":"96","author":"Fern\u00e1ndez-Cruz","year":"2017","journal-title":"Medicine (Baltimore)"},{"key":"2025062505201741900_ofaf287-B24","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1586\/14779072.2013.832482","article-title":"Enterococcus faecalis infective endocarditis: focus on clinical aspects","volume":"11","author":"Dahl","year":"2013","journal-title":"Expert Rev Cardiovasc Ther"},{"key":"2025062505201741900_ofaf287-B25","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1007\/s10096-023-04636-3","article-title":"Recurrent bacteremia with Enterococcus faecalis, the clinical findings predicting endocarditis, and genomic characterization of the isolates: a retrospective cohort study","volume":"42","author":"Tellapragada","year":"2023","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2025062505201741900_ofaf287-B26","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1007\/s10096-021-04210-9","article-title":"Short time to blood culture positivity in Enterococcus faecalis infective endocarditis","volume":"40","author":"Oldberg","year":"2021","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2025062505201741900_ofaf287-B27","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1111\/1469-0691.12236","article-title":"Incidence, clinical characteristics and 30\u2013day mortality of enterococcal bacteraemia in Denmark 2006\u20132009: a population-based cohort study","volume":"20","author":"Pinholt","year":"2014","journal-title":"Clin Microbiol Infect"},{"key":"2025062505201741900_ofaf287-B28","doi-asserted-by":"crossref","first-page":"2434","DOI":"10.1016\/j.jacc.2019.08.1040","article-title":"Prevalence of infective endocarditis in Enterococcus faecalis bacteremia, methodology issues","volume":"74","author":"Zhou","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2025062505201741900_ofaf287-B29","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1097\/00005792-198807000-00005","article-title":"Enterococcal bacteremia: clinical features, the risk of endocarditis, and management","volume":"67","author":"Maki","year":"1988","journal-title":"Medicine (Baltimore)"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofaf287\/63151869\/ofaf287.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/12\/6\/ofaf287\/63151869\/ofaf287.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/12\/6\/ofaf287\/63151869\/ofaf287.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T09:20:28Z","timestamp":1750843228000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofaf287\/8128787"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,12]]},"references-count":29,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,5,31]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofaf287","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,6]]},"published":{"date-parts":[[2025,5,12]]},"article-number":"ofaf287"}}