External Validation of the PACTO Risk Score for Infective Endocarditis in Patients With Coagulase-Negative Staphylococcal Bacteremia: A Multicenter Cohort Study.
13 affiliations
- 1Infectious Diseases Unit, Hospital Universitario Puerta de Hierro, Autonomous University of Madrid, Instituto Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHSA), Majadahonda, Spain.
- 2Infectious Diseases Unit, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHSA), Madrid, Spain.
- 3Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain.
- 4Facultad de Medicina, Universidad de Sevilla, Seville, Spain.
- 5Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Sevilla, Spain.
- 6CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
- 7Infectious Diseases Unit, Department of Internal Medicine, Complejo Asistencial Universitario de Salamanca, University of Salamanca, Instituto Investigación Biomédica de Salamanca, Salamanca, Spain.
- 8Infectious Diseases Unit, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria de la Princesa (IIS-P), Madrid, Spain.
- 9Servicio 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.
- 10Department of Internal Medicine, Complejo Asistencial Universitario de Salamanca, Spain.
- 11Department of Biomedical Sciences, Humanitas University, Milan, Italy.
- 12Infectious Diseases Unit, IRCCS Humanitas Research Hospital, Milan, Italy.
- 13Infectious Diseases Unit, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria de la Princesa (IIS-P), Madrid, Spain.
Abstract
Background
Coagulase-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
We 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
Definite 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
This 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.
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BibTeX
@article{ramosmartinez2026external,
title = {{External Validation of the PACTO Risk Score for Infective Endocarditis in Patients With Coagulase-Negative Staphylococcal Bacteremia: A Multicenter Cohort Study.}},
author = {Antonio Ramos-Martínez and Itziar Diego-Yagüe and Luis Eduardo López-Cortés and María Sánchez-Ledesma and Carmen Sáez-Béjar and Carmen Hidalgo-Tenorio and Marta Murga de la Fuente and Jesús Rodríguez-Baño and David Puertas-Miranda and Benedetta Varisco and Marianela Ciudad-Sañudo and Inmaculada López-Hernández and Jorge Calderón-Parra},
journal = {Open forum infectious diseases},
year = {2026},
month = sep,
doi = {10.1093/ofid/ofag599},
url = {https://europepmc.org/article/MED/42921184},
note = {CC BY},
}
RIS
TY - JOUR
TI - External Validation of the PACTO Risk Score for Infective Endocarditis in Patients With Coagulase-Negative Staphylococcal Bacteremia: A Multicenter Cohort Study.
AU - Antonio Ramos-Martínez
AU - Itziar Diego-Yagüe
AU - Luis Eduardo López-Cortés
AU - María Sánchez-Ledesma
AU - Carmen Sáez-Béjar
AU - Carmen Hidalgo-Tenorio
AU - Marta Murga de la Fuente
AU - Jesús Rodríguez-Baño
AU - David Puertas-Miranda
AU - Benedetta Varisco
AU - Marianela Ciudad-Sañudo
AU - Inmaculada López-Hernández
AU - Jorge Calderón-Parra
PY - 2026
DA - 2026/09/23
JO - Open forum infectious diseases
DO - 10.1093/ofid/ofag599
UR - https://europepmc.org/article/MED/42921184
AB - Background Coagulase-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 We 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 Definite 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 This 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.
SN - 2328-8957
ER -