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Marseille scoring system for empiric treatment of infective endocarditis

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European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Despite advances in medical, surgical, and critical care, infective endocarditis (IE) remains associated with considerable morbidity and mortality. We evaluated the performance of the Marseille score, including clinical data and biological tests obtained within 2 h, to identify patients at high risk of IE in order to initiate early antimicrobial treatment. This was secondarily confirmed using modified ESC criteria combined with molecular testing and (18)fluorodeoxyglucose-positron emission tomography/computed tomography as diagnostic tools. In a prospective cohort study, we enrolled 484 patients with cardiovascular predisposition and clinical suspicion of IE from 2011 to 2013. The final diagnosis was definite IE in 123 patients and possible IE in 107. Marseille score was calculated adding one point for each present parameter (range 0–9). This score includes clinical, epidemiological (male, fever, splenomegaly, clubbing, vascular disease and stroke) and biological criteria (Leucocytes >10,000/mm3, sedimentation rate (SR) > 50/mm or C reactive protein >10 mg/L and hemoglobin <100 g/l). A score of 2 or more performed best in predicting IE in patients with predisposing heart lesions. Sensitivity was better on left-side heart lesions (94%) than on right-side heart lesions (85%) (p = 0.04) and better for valvulopathy (94%) than intra cardiac devices (84%) (p = 0.02). The predictive positive value of prosthetic valves was greater than that of native valves (p = 0.02). Using our simple Marseille score combined with our standardized diagnostic procedures would help improve IE management by focusing on early empiric treatment within 2 h of admission for patients with cardiac predisposition factors.

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Acknowledgements

We thank Fatma Zaourar, Caroline Zaratzian and Hervé Richet for technical help. We thank Magdalen Lardière for English corrections. We thank Gaelle Valle for the manuscript review.

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Authors and Affiliations

  1. URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095, AP-HM, URMITE, IHU - Méditerranée Infection, 9-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France

    Frédérique Gouriet, Hervé Tissot-Dupont, Jean-Paul Casalta, Pierre-Edouard Fournier, Sophie Edouard, Hubert Lepidi & Didier Raoult

  2. IHU - Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France

    Frédérique Gouriet, Hervé Tissot-Dupont, Jean-Paul Casalta, Pierre-Edouard Fournier, Sophie Edouard & Didier Raoult

  3. Service de Cardiologie, Hôpital de la Timone, 13385, Marseille, France

    Sandrine Hubert & Gilbert Habib

  4. Service de Chirurgie Cardiaque, Hôpital de la Timone, 13385, Marseille, France

    Alexis Theron & Dominique Grisoli

Authors
  1. Frédérique Gouriet
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  2. Hervé Tissot-Dupont
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  3. Jean-Paul Casalta
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  4. Sandrine Hubert
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  5. Pierre-Edouard Fournier
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  6. Sophie Edouard
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  7. Alexis Theron
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  8. Hubert Lepidi
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  9. Dominique Grisoli
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  10. Gilbert Habib
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  11. Didier Raoult
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Corresponding author

Correspondence to Frédérique Gouriet.

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Gouriet, F., Tissot-Dupont, H., Casalta, JP. et al. Marseille scoring system for empiric treatment of infective endocarditis. Eur J Clin Microbiol Infect Dis 37, 841–849 (2018). https://doi.org/10.1007/s10096-017-3177-3

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  • DOI: https://doi.org/10.1007/s10096-017-3177-3

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