Variation Among Infectious Diseases Pharmacists for the Treatment of Staphylococcus aureus Bacteremia

Abstract

Introduction Staphylococcus aureus bacteremia (SAB) remains complex, in that optimal treatment for patients, including complicated or persistent infection, remains unclear. Two recent surveys have demonstrated practice variations in SAB among infectious diseases (ID) physicians. Objectives The purpose of this survey was to examine practice variations in SAB among ID pharmacists. Methods A thirty-five-question survey was electronically distributed to the American College of Clinical Pharmacy (ACCP) Infectious Diseases Practice and Research Network (IDPRN) in Fall 2019 to determine differences in SAB management. Data were analyzed utilizing Pearson’s Chi-Square or Fisher’s Exact Test. Results A total of 106 ID pharmacists responded. Only 28% of pharmacists practiced at hospitals with mandatory ID consultation for SAB. A majority (75%) had rapid diagnostic technology (RDT) for identifying SABSI, but 32% of those facilities with RDT did not notify pharmacy with results. Anti-staphylococcal penicillins were preferred for MSSA blood stream infections (BSI) in patients with central nervous system infection and endocarditis, whereas cefazolin was favored for other MSSA BSI. For persistent MRSA BSI, 34% selected daptomycin alone while 38% elected to combine daptomycin and ceftaroline. Pharmacists at hospitals less than 500 beds were more likely to use daptomycin, while those at larger hospitals were more likely to use daptomycin and ceftaroline for persistent MRSA BSI ( P < .05). Conclusions A survey of ID pharmacists showed variation in the management of SABs, as well as the definition and treatment of persistent SAB. Mandatory ID consultation and RDT use to improve SAB management have not been optimized.

Treatment decisions in VRE bacteraemia: a survey of infectious diseases pharmacists

“…Our study is not without limitations. Our sample size ( n = 68) was smaller than other previous surveys of the ACCP ID PRN, 17 but similar in size to a survey of the ACCP ID PRN on outpatient parenteral antimicrobial therapy (OPAT) ( n = 87). 36 With the majority of respondents in our survey having 10 years or less of practice, it may have led to bias.…”

“…The methods were similar to our previous survey on SAB. 17 All authors had previous experience with survey development. The authors developed the survey to focus on unanswered questions or topics surrounding VRE BSI based on a recent review of the literature for VRE BSI that demonstrated mortality advantages with daptomycin therapy, highlighted the uncertainties of managing daptomycin non-susceptible VRE BSI, and questioned the role of combination therapy.…”

“…Unlike Staphylococcus aureus bacteraemia (SAB) where multiple surveys of treatment preferences of infectious diseases (ID) pharmacists 17 and ID physicians 18 , 19 are available, similar data are not available for VRE BSI. SAB treatment surveys demonstrated variation among clinicians in different types of hospitals and areas of the country.…”

Therapeutic Options for Adult Patients With Persistent Methicillin-Susceptible Staphylococcus aureus Bacteremia: A Narrative Review

“…The investigators required infectious diseases consultations for all patients, which has been shown to decrease mortality in SAB, but is mandatory in only 28% of hospitals. 71,72 In addition, only 36% of patients were bacteremic at the time of enrollment. These observations likely explain the lower overall 12-week all-cause mortality of 15% when compared with a 90-day all-cause mortality of 26% observed from the large prospective US cohort.…”

Rapid Diagnostic Test Value and Implementation in Antimicrobial Stewardship Across Low-to-Middle and High-Income Countries: A Mixed-Methods Review

“…In some way, the coronavirus disease 2019 pandemic has highlighted the global societal value of RDTs and raised awareness of the importance of diagnostic capabilities [ 6 – 8 ]. However, global use of RDTs as part of antimicrobial stewardship programmes (ASPs) remains low [ 9 , 10 ].…”