VIRSTA Score for Infective Endocarditis Risk in Bacteraemia
Clinical prediction rule identifying patients with Staphylococcus aureus bacteraemia at high risk for infective endocarditis requiring echocardiography. Validated in French multicentre cohorts. Score at or above 3 indicates echocardiography is required.
Score interpretation
VIRSTA under 3 — low risk of infective endocarditis complicating SAB
→ Standard SAB management; IV anti-staphylococcal antibiotic (flucloxacillin or vancomycin if MRSA); minimum 2-week IV course; repeat blood cultures at 48 to 72 hours; if bacteraemia persists despite treatment: echocardiography required regardless of VIRSTA score; source control; infectious disease specialist input
VIRSTA 3 or above — significant risk of IE; echocardiography required
→ TTE within 24 to 48 hours; if TTE inadequate or prosthetic valve: TOE; if IE confirmed: 4 to 6 week IV antibiotic course per ESC IE guidelines; cardiothoracic surgery referral if surgical criteria met (vegetation above 10 mm, perivalvular abscess, haemodynamic compromise); infectious disease and cardiology MDT; prolonged follow-up echocardiography at 1, 3, and 6 months
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 echocardiography. J Infect. 2016;72(5):544-553.
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.