Management of bloodstream infections by infection specialists: an international ESCMID cross-sectional survey.
Int J Antimicrob Agents. 2018 Jan 05;:
Authors: Diallo K, Thilly N, Luc A, Beraud G, Ergonul Ö, Giannella M, Kofteridis D, Kostyanev T, Paňo-Pardo JR, Retamar P, Kern W, Pulcini C, ESGAP and ESGBIS
BACKGROUND: Bloodstream infections (BSI) are frequent, but international guidelines are available only for MRSA and candidaemia.
OBJECTIVES: Our objective was to explore the management of BSI by infection specialists.
METHODS: This international ESCMID cross-sectional survey was opened from December 2016 to February 2017. All infection specialists, senior or trainees, giving at least weekly advice on positive blood cultures could participate. Their practices were evaluated using six clinical vignettes presenting uncomplicated BSI cases.
RESULTS: Six hundred and sixteen professionals from 56 countries participated (333/616, 54% infectious diseases specialists, 188/616, 30% clinical microbiologists), 76% (468/616) being members of an antimicrobial stewardship team. Large variations in practice were noted, in particular for the E. coli, E. faecalis and P. aeruginosa vignettes. Echocardiography was considered standard of care by 81% (373/459) of participants for MRSA, 78% (400/510) for MSSA and 60% (236/395) for C. albicans. Antimicrobial combination therapy was recommended by 2% (8/360) of the respondents for C. albicans, 11% (43/378) for E. coli, 27% (114/420) for MRSA and 39% (155/393) for E. faecalis. IV-oral switch was considered in 68% (285/418) for MRSA, 79% (306/388) for E. faecalis, 72% (264/366) for P. aeruginosa and 75% (270/362) for C. albicans. In multivariable analysis, IDSA guideline-compliant practice was more frequent among participants belonging to an antimicrobial stewardship team (aOR 1.7, p=0.018 for the MRSA vignette and aOR 2.0, p=0.008 for the candidaemia one).
CONCLUSION: Our survey showed large variations in practice among infection specialists. International guidelines on management of BSI are urgently needed.
PMID: 29309899 [PubMed - as supplied by publisher]