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How do physicians cope with controversial topics in existing guidelines for the management of infective endocarditis? Results of an international survey.
Clin Microbiol Infect. 2015 Oct 19;
Authors: Béraud G, Pulcini C, Paño-Pardo JR, Hoen B, Beovic B, Nathwani D, ESGAP
Abstract
International guidelines are available to help physicians prescribe appropriate antibiotic regimens to patients with infective endocarditis (IE). However some topics of these guidelines are controversial. We conducted an international survey to assess physicians' adherence to these guidelines, focusing on these controversial items. An invitation to participate to a 15-question online survey was sent in 2012-2013 to ESCMID members, scientific societies and corresponding authors of publications on IE mentioned in Pubmed from 1990 to 2012, inclusive. Eight hundred and thirty-seven physicians participated in the survey and 625 (74.7%) completed it over the first question. The results showed great heterogeneity of practices. Claiming to follow guidelines was marginally associated with more guidelines-based strategies. Gentamicin use depended on causative pathogens (p<0.001) and physician's specialty (p=0.02). Eighty-six percent of the physicians favoured vancomycin alone or in combination with gentamicin or rifampicin as a first-line treatment for left-sided native valve MRSA IE, 31% considered switching to oral therapy as a therapeutic option and 33% used the ampicillin and ceftriaxone combination for enterococcal IE as a first-line therapy. Physician's specialty significantly impacted the choice of a therapeutic strategy, while practicing in a university hospital or the number of years of practice had virtually no impact. Our survey, the largest on infective endocarditis treatment, underscores important heterogeneity in practices for treatment of IE. Nonetheless, physicians who do not follow guidelines can have very rational strategies based on literature. These results could inform the revision of future guidelines, and identify unmet need for future studies.
PMID: 26493845 [PubMed - as supplied by publisher]