Clinical practice variation in the management of Staphylococcus aureus bacteremia amongst adult infectious disease physicians
AIM: We examined variation in clinical management of Staphylococcus aureus bacteremia (SAB) amongst infectious disease (ID) physicians in Singapore. BACKGROUND: ID specialist consultation for patients with SAB has proven to improve clinical outcomes, substantial variations in clinical practice conti...
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| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-12-01
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| Series: | Journal of Global Antimicrobial Resistance |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213716524003163 |
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| Summary: | AIM: We examined variation in clinical management of Staphylococcus aureus bacteremia (SAB) amongst infectious disease (ID) physicians in Singapore. BACKGROUND: ID specialist consultation for patients with SAB has proven to improve clinical outcomes, substantial variations in clinical practice continue to exist. METHODS: We sought to examine this variation by administering a standardized survey previously used by the Emerging Infections Network to 21 adult ID physicians from 2 tertiary hospitals in Singapore. RESULTS: The overall response rate was 71.4%. In terms of valve imaging, transthoracic echocardiogram is the initial modality of choice for all responders. All responders will treat uncomplicated methicillin-resistant SAB with 14 days of intravenous vancomycin. 14/15 (93.3%) responders would not transit from intravenous to oral antibiotics in patients with uncomplicated SAB. For methicillin-resistant SAB, 11/15 (73.3%) would continue IV vancomycin despite a minimum inhibitory concentration (MIC) of 2.0 if there is clinical and microbiological response; in contrast, only 5/15 (33.3%) would continue vancomycin in the context of methicillin-resistant Staphylococcus aureus endocarditis and persistent bacteremia at day 6, even if MIC is 0.5. For methicillin-susceptible Staphylococcus aureus endocarditis, 12/15 (80%) prefer the use of cloxacillin over cefazolin whilst 3/15 (20%) consider both drugs equivalent. Responses were split regarding the use of anticoagulation and treatment duration in SAB central line-associated septic thrombophlebitis. CONCLUSIONS: Substantial variation in the management of SAB among ID physicians in Singapore is observed. This suggests that more can be done to standardize best practices and address unresolved management questions in this common but potentially morbid infection. |
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| ISSN: | 2213-7165 |