Global Differences in the Management of Staphylococcus aureus Bacteremia: No International Standard of Care

Abstract Background Despite being the leading cause of mortality from bloodstream infections worldwide, little is known about regional variation in treatment practices for Staphylococcus aureus bacteremia (SAB). The aim of this study was to identify global variation in management, diagnostics, and d...

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Published in:Clinical infectious diseases 2023-10, Vol.77 (8), p.1092-1101
Main Authors: Westgeest, Annette C, Buis, David T P, Sigaloff, Kim C E, Ruffin, Felicia, Visser, Leo G, Yu, Yunsong, Schippers, Emile F, Lambregts, Merel M C, Tong, Steven Y C, de Boer, Mark G J, Fowler, Vance G
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - therapeutic use
Bacteremia - diagnosis
Bacteremia - drug therapy
Humans
Major
Methicillin-Resistant Staphylococcus aureus
Positron Emission Tomography Computed Tomography
Standard of Care
Staphylococcal Infections - diagnosis
Staphylococcal Infections - drug therapy
Staphylococcal Infections - epidemiology
Staphylococcus aureus - physiology
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Summary:Abstract Background Despite being the leading cause of mortality from bloodstream infections worldwide, little is known about regional variation in treatment practices for Staphylococcus aureus bacteremia (SAB). The aim of this study was to identify global variation in management, diagnostics, and definitions of SAB. Methods During a 20-day period in 2022, physicians throughout the world were surveyed on SAB treatment practices. The survey was distributed through listservs, e-mails, and social media. Results In total, 2031 physicians from 71 different countries on 6 continents (North America [701, 35%], Europe [573, 28%], Asia [409, 20%], Oceania [182, 9%], South America [124, 6%], and Africa [42, 2%]) completed the survey. Management-based responses differed significantly by continent for preferred treatment of methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) bacteremia, use of adjunctive rifampin for prosthetic material infection, and use of oral antibiotics (P < .01 for all comparisons). The 18F-FDG PET/CT scans were most commonly used in Europe (94%) and least frequently used in Africa (13%) and North America (51%; P < .01). Although most respondents defined persistent SAB as 3–4 days of positive blood cultures, responses ranged from 2 days in 31% of European respondents to 7 days in 38% of Asian respondents (P < .01). Conclusions Large practice variations for SAB exist throughout the world, reflecting the paucity of high-quality data and the absence of an international standard of care for the management of SAB. In this survey-based study we highlight the existence of large practice variations for Staphylococcus aureus bacteremia throughout the world.
ISSN:1058-4838
1537-6591
DOI:10.1093/cid/ciad363