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Risk scoring tools like HANDOC and CH-A improved infective endocarditis detection in NBHS bloodstream infections but increased transesophageal echocardiography use.

In a study published in the June 2025 issue of Infectious Disease, non-β-hemolytic streptococci (NBHS) were identified as important causes of blood stream infections (BSI), which were often complicated by infective endocarditis (IE), prompting interest in risk stratification tools to support clinical decision-making.  

Researchers conducted a retrospective study to compare the sensitivity, specificity, and impact on transesophageal echocardiography (TEE) use of the HANDOC and Chamat-Hedemand algorithm (CH-A) risk stratification systems (RSSs).  

They performed a population-based cohort analysis of individuals with blood cultures positive for NBHS during 2018. Medical records were reviewed to classify each episode using the HANDOC score, CH-A, and Duke-ISCVID criteria.  

The results showed that 325 episodes of 308 individuals with NBHS BSIs were analyzed. A total of 21 episodes (6.5%) fulfilled the duke-ISCVID criteria for definite IE. The TEE was utilized in 26% of cases. The HANDOC score demonstrated 95% sensitivity and 73% specificity for diagnosing definite IE, while the CH-A showed 90% sensitivity and 63% specificity. The CH-A criterion of ‘any echocardiography’ yielded 100% sensitivity and 24% specificity. Applying HANDOC and CH-A would have increased TEE use by 22% and 60%, respectively, compared to actual clinical practice.  

Investigators concluded that HANDOC demonstrated superior diagnostic accuracy for IE, and both RSSs increased TEE use, particularly with CH-A. 

Source: tandfonline.com/doi/full/10.1080/23744235.2025.2513537