Practices vary among clinicians in diagnosing and managing Staphylococcus aureus bacteremia in adults, according to a study published in Clinical Infectious Diseases. This underscores the need for the designation of best practices in management of these cases.

This study included survey responses from 723 physicians recruited from the Infectious Diseases Society of America’s Emerging Infections Network. The survey included 11 multiple-choice questions designed to gather information on opinions and methodology in managing S aureus bacteremia. The overall response rate to the survey was 56% (723/1286). Those who responded to the survey were more likely to have >25 years of experience with infectious diseases than those who did not respond (30% vs 21%; P <.0001).

Results demonstrated that the majority of respondents indicated they would perform repeat blood cultures for a patient with S aureus bacteremia. Approximately 90% of clinicians reported always ordering a transthoracic echocardiogram, though this was more common among physicians with <15 years of experience (93% vs 86%; P=.01).

When asked about treatment preference for patients with left-sided methicillin-susceptible S aureus endocarditis with no involvement from the central nervous system, 29% of respondents chose nafcillin, 32% chose cefazolin, and 32% felt the two treatments were interchangeable. Of note, 169 of the 193 clinicians who chose nafcillin, reported using it as it is cited as ‘gold standard’ therapy. The majority indicated they would choose vancomycin (51%) vs daptomycin (37%) or ceftaroline (4%) to manage methicillin-resistant S aureus bacteremia in a patient with a minimum inhibitory concentration for vancomycin of 2 mg/L.

Approximately 75% of respondents reported they would modify therapy in patient with methicillin-resistant S aureus endocarditis and persistent bacteremia should there be no change by day 6 of therapy. Alternative monotherapy was selected by 245 (37%) respondents while 215 (32%) chose combination therapy; in those who chose another single agent, 193 (78%) selected daptomycin while 36 (15%) chose ceftaroline. In regards to length of treatment, an intravenous antibiotic treatment duration of ≥14 days was selected by most respondents.

Limitations to this study included potential selection bias and a resultant lack of generalizability, as well as response bias, which potentially misrepresented clinical practice.

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The study researchers concluded that “[while] there were areas of consensus, we found substantial practice variation in diagnostic evaluation and management of adult patients with [S aureus bacteremia].”

Authors C Liu and HF Chambers report financial associations with pharmaceutical companies.

Reference

Liu C, Strnad L, Beekmann SE, Polgreen PM, Chambers HF. Clinical practice variation among adult infectious diseases physicians in the management of Staphylococcus aureus bacteremia [published online January 2, 2019]. Clin Infect Dis. doi: 10.1093/cid/ciy1144