Clinical Practice Variation Among Adult Infectious Disease Physicians in the Management of Staphylococcus aureus Bacteremia

Abstract

Infectious disease management of Staphylococcus aureus bacteremia (SAB) was surveyed through the Emerging Infections Network. Although there were areas of consensus, we found substantial practice variation in diagnostic evaluation and management of adult patients with SAB. These findings highlight opportunities for further research and guidance to define best practices.

Keywords: Staphylococcus aureus; bacteremia; infectious disease physicians.

Figure 1.

Practice patterns among survey respondents on the diagnostic evaluation and management of Staphylococcus aureus bacteremia (SAB). A, Diagnostic workup routinely performed in the evaluation of a patient with SAB. B, Respondents indicating they would perform transthoracic echocardiogram (TTE) on every patient but only perform transesophageal echocardiogram (TEE) under these selected circumstances (n = 473). C, Management of patient with methicillin-resistant Staphylococcus aureus endocarditis and persistent SAB on day 6 of vancomycin, with therapeutic trough and vancomycin MIC of .5 mg/L. D, Factors influencing decision to extend duration of therapy from 2 weeks to 4–6 weeks assuming negative echocardiography (TTE and/or TEE). Abbreviations: Abd, abdominal; cx, culture; CT, computed tomography; MRI, magnetic resonance imaging; MRSA, methicillin-resistant Staphylococcus aureus; TEE, transesophageal echocardiogram; TTE, transthoracic echocardiogram. *Among 222 respondents who commented on other clinical factors that would prompt TEE, common responses included presence of cardiac device or prosthetic valve (58 [26%]); clinical suspicion for infective endocarditis including embolic phenomenon or metastatic infection (43 [19%]); or TEE results would change management (eg, duration of therapy, surgical management) (36 [16%]).