{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T12:53:06Z","timestamp":1776084786858,"version":"3.50.1"},"reference-count":25,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Background: Early identification of Staphylococcus spp. infective endocarditis (IE) remains clinically challenging but essential for timely initiation of targeted antimicrobial therapy. We aimed to characterize pathogen-specific clinical phenotypes and to develop a pragmatic bedside prediction model for staphylococcal etiology. Methods: We conducted a retrospective cohort study including 112 patients diagnosed with definite IE. Demographic, clinical, echocardiographic, and laboratory data were analyzed. Independent predictors of staphylococcal etiology were identified using multivariable logistic regression, with internal validation by bootstrap resampling. A simplified clinical risk score was derived from regression coefficients. Platelet kinetics were evaluated as a potential complementary biomarker. Results: Patients with staphylococcal IE (n = 66) were younger and exhibited a distinct clinical profile characterized by a high prevalence of intravenous drug use, right-sided valve involvement, and a markedly elevated inflammatory response. Independent predictors included intravenous drug use (OR 7.1, 95% CI 2.45\u201320.6, p &lt; 0.001), higher C-reactive protein levels (OR 1.08 per unit increase, p = 0.025), and lower oxygen saturation (OR 0.75 per 1% increase, p = 0.007). The model demonstrated good discrimination (AUC 0.82, 95% CI 0.74\u20130.90) and calibration. The simplified exploratory risk score stratified patients into low-, intermediate-, and high-risk groups, with observed probabilities of 27%, 82%, and 94%, respectively. Conclusions: Staphylococcal IE represents a distinct clinical phenotype. A simple three-variable model enables early bedside identification of high-probability cases and may support risk-adapted management decisions. Nevertheless, external validation is required before clinical implementation of a score.<\/jats:p>","DOI":"10.3390\/pathogens15040418","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T11:38:26Z","timestamp":1776080306000},"page":"418","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Phenotype-Based Stratification and Early Prediction of Staphylococcal Infective Endocarditis: Development of a Pragmatic Bedside Score"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-9379-432X","authenticated-orcid":false,"given":"Adina-Alexandra","family":"Nanu","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"\u201cDr. Victor Babe\u0219\u201d Clinical Hospital of Infectious and Tropical Diseases, 030303 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0712-875X","authenticated-orcid":false,"given":"Miruna-Ioana","family":"Laz\u0103r","sequence":"additional","affiliation":[{"name":"\u201cNicolae Malaxa\u201d Clinical Hospital, 022441 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9772-2482","authenticated-orcid":false,"given":"Drago\u0219 \u0218tefan","family":"Laz\u0103r","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"\u201cDr. Victor Babe\u0219\u201d Clinical Hospital of Infectious and Tropical Diseases, 030303 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6316-0333","authenticated-orcid":false,"given":"Corneliu Petru","family":"Popescu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"\u201cDr. Victor Babe\u0219\u201d Clinical Hospital of Infectious and Tropical Diseases, 030303 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Nica","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"\u201cDr. Victor Babe\u0219\u201d Clinical Hospital of Infectious and Tropical Diseases, 030303 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6482-3386","authenticated-orcid":false,"given":"Simin Aysel","family":"Florescu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"\u201cDr. Victor Babe\u0219\u201d Clinical Hospital of Infectious and Tropical Diseases, 030303 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Mart\u00ednez-Sell\u00e9s, M., and Mu\u00f1oz, P. (2023). Epidemiology, Diagnosis, Treatment, and Prognosis of Infective Endocarditis. J. Clin. Med., 12.","DOI":"10.3390\/jcm12175705"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.tcm.2024.01.001","article-title":"Update on the epidemiology, diagnosis, and management of infective endocarditis: A review","volume":"34","author":"Miao","year":"2024","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Reisinger, M., Kachel, M., and George, I. (2024). Emerging and Re-Emerging Pathogens in Valvular Infective Endocarditis: A Review. Pathogens, 13.","DOI":"10.3390\/pathogens13070543"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"425","DOI":"10.5194\/jbji-10-425-2025","article-title":"Infective endocarditis meets native vertebral osteomyelitis: A mortality perspective","volume":"10","author":"Borgonovo","year":"2025","journal-title":"J. Bone Jt. Infect."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e2451353","DOI":"10.1001\/jamanetworkopen.2024.51353","article-title":"\u03b2-Lactam Inoculum Effect in Methicillin-Susceptible Staphylococcus aureus Infective Endocarditis","volume":"7","author":"Jean","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1080\/23744235.2025.2556921","article-title":"Staphylococcus lugdunensis infective endocarditis: A multicentre international observational study","volume":"58","author":"Lefevre","year":"2025","journal-title":"Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Kedsawadevong, P., Jamnongprasatporn, S., and Ratanasit, N. (2024). Streptococcus suis infective endocarditis in patients with Streptococcus suis bacteremia: A retrospective study of prevalence and outcomes. BMC Infect. Dis., 24.","DOI":"10.1186\/s12879-024-10180-y"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1093\/cid\/ciae003","article-title":"Evaluation of the 2023 Duke-ISCVID and 2023 Duke-ESC Clinical Criteria for the Diagnosis of Infective Endocarditis in a Multicenter Cohort of Patients With Staphylococcus aureus Bacteremia","volume":"78","author":"Monney","year":"2024","journal-title":"Clin. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1093\/cid\/ciae628","article-title":"Time to Staphylococcus aureus Blood Culture Positivity as a Risk Marker of Infective Endocarditis: A Retrospective Cohort Study","volume":"80","author":"Hagman","year":"2025","journal-title":"Clin. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"133","DOI":"10.36519\/idcm.2024.327","article-title":"Prospective Clinical Follow-Up Results of Infective Endocarditis","volume":"6","author":"Arslan","year":"2024","journal-title":"Infect. Dis. Clin. Microbiol."},{"key":"ref_11","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":"ref_12","first-page":"188","article-title":"Charlson Comorbidity Index: ICD-9 Update and ICD-10 Translation","volume":"12","author":"Glasheen","year":"2019","journal-title":"Am. Health Drug Benefits"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"967","DOI":"10.31083\/j.rcm2203105","article-title":"Validity of SOFA score as a prognostic tool for critically ill elderly patients with acute infective endocarditis","volume":"22","author":"Lin","year":"2021","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1016\/j.jiac.2019.05.014","article-title":"The SOFA score could predict the severity and prognosis of infective endocarditis","volume":"25","author":"Asai","year":"2019","journal-title":"J. Infect. Chemother."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1007\/s15010-024-02444-1","article-title":"Embolic complications in a large contemporary cohort of infective endocarditis: Do we need score model?","volume":"53","author":"Bertolino","year":"2024","journal-title":"Infection"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e003060","DOI":"10.1136\/openhrt-2024-003060","article-title":"Embolic risk management in infective endocarditis: Predicting the \u2018embolic roulette\u2019","volume":"12","author":"Serban","year":"2025","journal-title":"Open Heart"},{"key":"ref_17","first-page":"e91270","article-title":"Infective Endocarditis in Patients with a History of Intravenous Drug Abuse","volume":"17","author":"Bursy","year":"2025","journal-title":"Cureus"},{"key":"ref_18","first-page":"e93293","article-title":"Infective Endocarditis in Special Populations: Epidemiology, Diagnostic Challenges, and Management Strategies","volume":"17","author":"Sidik","year":"2025","journal-title":"Cureus"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"49","DOI":"10.55729\/2000-9666.1549","article-title":"Infective Endocarditis with Coronary Artery Embolization and Multisystem Involvement in a Patient with a History of IV Drug Use: A Case Report","volume":"15","author":"Moiz","year":"2025","journal-title":"J. Community Hosp. Intern. Med. Perspect."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Nanu, A.A., Laz\u0103r D\u0218tefan Popescu, C.P., Laz\u0103r, M.I., Nica, M., and Florescu, S.A. (2025). Characteristics of Infective Endocarditis in Intravenous Drug Users vs. Non-Users: A Retrospective Study Conducted in Bucharest, Romania. Medicina, 61.","DOI":"10.3390\/medicina61101785"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1989","DOI":"10.1007\/s10096-024-04848-1","article-title":"Clinical features and prognosis of prosthetic valve endocarditis due to Staphylococcus aureus","volume":"43","author":"Machado","year":"2024","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1007\/s12055-023-01616-2","article-title":"Systemic embolization in infective endocarditis","volume":"40","author":"Kildahl","year":"2023","journal-title":"Indian J. Thorac. Cardiovasc. Surg."},{"key":"ref_23","first-page":"1","article-title":"Staphylococcus aureus aggregation and coagulation mechanisms, and their function in host-pathogen interactions","volume":"96","author":"Crosby","year":"2016","journal-title":"Adv. Appl. Microbiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1111\/jth.13928","article-title":"Staphylococcus aureus, master manipulator of the human hemostatic system","volume":"16","author":"Liesenborghs","year":"2018","journal-title":"J. Thromb. Haemost."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"12933","DOI":"10.1038\/s41598-022-16681-7","article-title":"Staphylococcus aureus increases platelet reactivity in patients with infective endocarditis","volume":"12","author":"Polzin","year":"2022","journal-title":"Sci. Rep."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/15\/4\/418\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T12:03:27Z","timestamp":1776081807000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/15\/4\/418"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,13]]},"references-count":25,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["pathogens15040418"],"URL":"https:\/\/doi.org\/10.3390\/pathogens15040418","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,13]]}}}