VIRSTA Score for Infective Endocarditis Risk in Bacteraemia
VIRSTA (Tubiana 2016): risk of infective endocarditis in adults with Staphylococcus aureus bacteraemia, assessed within 48 hours, to prioritise echocardiography. Score ≥ 3: echocardiography.
Score interpretation
VIRSTA ≤ 2: infective endocarditis in 1.1% (negative predictive value 98.8%; Tubiana 2016).
→ Treat the bacteraemia; echocardiography can be deferred, but perform it if bacteraemia persists, the clinical picture changes or a device or prosthetic valve is present; infection specialist input.
VIRSTA ≥ 3: infective endocarditis in 17.4% (Tubiana 2016).
→ Urgent echocardiography (TTE, with TOE if TTE is non-diagnostic or a prosthetic valve or device is present); endocarditis team input.
Interpretation bands for the VIRSTA Score. Apply clinical judgement and local guidance.
References
- Tubiana S et al. The VIRSTA score, a prediction score to estimate risk of infective endocarditis and determine priority for echocardiography in patients with Staphylococcus aureus bacteremia. J Infect. 2016;72(5):544-553.
- van der Vaart TW et al. Prediction rules for ruling out endocarditis in patients with Staphylococcus aureus bacteremia. Clin Infect Dis. 2022;74(8):1442–1449.
Related
Curated clinical cross-links plus same-class fallbacks.
- Daptomycin · Cyclic Lipopeptide — MRSA / VRE / Bacteraemia / Endocarditis
- Palivizumab · RSV Prophylaxis — Monthly Monoclonal Antibody (High-Risk Infants)
- Ziprasidone · Atypical Antipsychotic — D2/5-HT2A Antagonist (Low Metabolic Risk)
- Atorvastatin (CKD Cardiovascular Risk) · Cardiovascular Risk in CKD
- Icosapent Ethyl (Omega-3 — Cardiovascular Risk Reduction) · Omega-3 Fatty Acid (Purified EPA — Eicosapentaenoic Acid Ethyl Ester)
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.