{ "abstract": "Background\n\nCoagulase-negative staphylococci (CoNS) are a leading cause of prosthetic-valve infective endocarditis (IE) and an emerging cause of native-valve IE. Identifying patients with CoNS bacteremia at high risk of IE remains a significant clinical challenge. The PACTO score, derived from a single-center cohort, integrates four early-available predictors of IE.Methods\n\nWe conducted a multicenter retrospective cohort study of 302 adults with true CoNS bacteremia who underwent echocardiography at several Spanish hospitals between October 2016 and September 2025. IE was diagnosed according to the 2023 Duke-ISCVID criteria. The PACTO score assigns points for prosthetic valve or pacemaker (4), all blood culture bottles positive (2), community-acquired bacteremia (2), and continuous bacteremia (positive cultures 12-72 hours apart; 1).Results\n\nDefinite IE was diagnosed in 60 patients (19.9%). The PACTO score showed excellent discrimination (AUC 0.828; 95% CI .773-.883) and good calibration (Hosmer-Lemeshow P = .360). IE prevalence increased progressively across risk categories, from 1.6% (0-1 points) to 84.6% (>7 points). A score <2 points yielded a negative predictive value of 98.4% (sensitivity 98.3%).Conclusions\n\nThis multicenter external validation demonstrates that the PACTO score provides robust risk stratification for IE in patients with CoNS bacteremia, supporting safe deferral of echocardiography in low-risk patients and prompt imaging in high-risk individuals. Prospective validation is warranted.", "abstract_shown": true, "affiliations": [ "Infectious Diseases Unit, Hospital Universitario Puerta de Hierro, Autonomous University of Madrid, Instituto Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHSA), Majadahonda, Spain.", "Infectious Diseases Unit, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHSA), Madrid, Spain.", "Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain.", "Facultad de Medicina, Universidad de Sevilla, Seville, Spain.", "Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Sevilla, Spain.", "CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.", "Infectious Diseases Unit, Department of Internal Medicine, Complejo Asistencial Universitario de Salamanca, University of Salamanca, Instituto Investigación Biomédica de Salamanca, Salamanca, Spain.", "Infectious Diseases Unit, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria de la Princesa (IIS-P), Madrid, Spain.", "Servicio de Enfermedades Infecciosas, Departamento de Medicina, Hospital Universitario Virgen de las Nieves, Granada, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Universidad de Granada, Spain.", "Department of Internal Medicine, Complejo Asistencial Universitario de Salamanca, Spain.", "Department of Biomedical Sciences, Humanitas University, Milan, Italy.", "Infectious Diseases Unit, IRCCS Humanitas Research Hospital, Milan, Italy.", "Infectious Diseases Unit, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria de la Princesa (IIS-P), Madrid, Spain." ], "article_type": "research article", "arxiv": null, "author_total": 13, "authors": [ { "affs": [ 0 ], "name": "Antonio Ramos-Martínez", "orcid": "0000-0002-4840-9425" }, { "affs": [ 1 ], "name": "Itziar Diego-Yagüe", "orcid": "0000-0002-3457-8359" }, { "affs": [ 2, 3, 4, 5 ], "name": "Luis Eduardo López-Cortés" }, { "affs": [ 6 ], "name": "María Sánchez-Ledesma", "orcid": "0000-0002-2388-8749" }, { "affs": [ 7 ], "name": "Carmen Sáez-Béjar", "orcid": "0000-0002-4657-4048" }, { "affs": [ 8 ], "name": "Carmen Hidalgo-Tenorio", "orcid": "0000-0002-6394-5728" }, { "affs": [ 1 ], "name": "Marta Murga de la Fuente" }, { "affs": [ 2, 3, 4, 5 ], "name": "Jesús Rodríguez-Baño", "orcid": "0000-0001-6732-9001" }, { "affs": [ 9 ], "name": "David Puertas-Miranda", "orcid": "0000-0002-0502-3741" }, { "affs": [ 10, 11 ], "name": "Benedetta Varisco" }, { "affs": [ 12 ], "name": "Marianela Ciudad-Sañudo", "orcid": "0000-0001-6187-7226" }, { "affs": [ 2, 3, 4, 5 ], "name": "Inmaculada López-Hernández" }, { "affs": [ 1 ], "name": "Jorge Calderón-Parra", "orcid": "0000-0002-0369-9369" } ], "bibtex": "https://research.draconitic.com/paper/cwm2p61c4rxeg.bib", "cited_by": 0, "doi": "10.1093/ofid/ofag599", "fulltext_url": "https://europepmc.org/articles/PMC13693480", "id": "cwm2p61c4rxeg", "issns": [ "2328-8957" ], "landing_url": "https://europepmc.org/article/MED/42921184", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2713|Infective Endocarditis Diagnosis and Management" ] ], "openalex": "W7214068697", "pdf_url": "https://europepmc.org/articles/PMC13693480?pdf=render", "pmcid": "PMC13693480", "pmid": "42921184", "published": "2026-09-23", "publisher": null, "ris": "https://research.draconitic.com/paper/cwm2p61c4rxeg.ris", "sources": [ { "first_seen": "2026-10-30T12:20:36Z", "native_id": "MED:42921184", "source": "europepmc", "url": "https://europepmc.org/article/MED/42921184" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2713|Infective Endocarditis Diagnosis and Management", "subfield": "epidemiology-public-health" } ], "title": "External Validation of the PACTO Risk Score for Infective Endocarditis in Patients With Coagulase-Negative Staphylococcal Bacteremia: A Multicenter Cohort Study.", "title_text": "External Validation of the PACTO Risk Score for Infective Endocarditis in Patients With Coagulase-Negative Staphylococcal Bacteremia: A Multicenter Cohort Study.", "type": "peer-reviewed", "updated_at": "2026-10-30T12:20:36Z", "url": "https://research.draconitic.com/paper/cwm2p61c4rxeg", "venue": "Open forum infectious diseases", "versions": [] }