Research noteComplicated and uncomplicated S. aureus bacteraemia: an international Delphi survey among infectious diseases experts on definitions and treatment
Introduction
It is recommended that patients with uncomplicated Staphylococcus aureus bacteraemia (SAB) (i.e. no infective endocarditis (IE) or implanted prostheses, defervescence <72 hours with effective therapy, sterile follow-up blood cultures, and no evidence of metastatic infection) should receive intravenous antibiotics for 14 days. All other patients are considered to have a complicated episode requiring 4–6 weeks of therapy [1,2]. However, the criteria to classify a SAB episode as complicated or uncomplicated are based on low-quality evidence, and there is controversy about the feasibility of oral stepdown therapy [3,4]. The aim of the study was to determine the degree of agreement among infectious diseases (ID) physicians in the treatment of patients with SAB.
Section snippets
Methods
A stepwise RAND-modified Delphi survey with two questionnaire rounds was performed between December 2020 and October 2021. To identify experts with clinical and research interests in SAB, we searched PubMed for physicians who have published and/or participated in studies on SAB and/or were members of guideline committees for SAB. Of 90 physicians invited, 33 (36.7%) from 14 countries and 5 continents consented to participate in the first questionnaire round; 27 participated in the second round
Classification of episodes
Overall, 7 of the 11 scenarios were classified as complicated SAB episodes during the first round. The patients' age was rated as not being relevant (median 2 (IQR 1–5)); for underlying immunosuppression (5 (IQR 3–6)) and chronic haemodialysis (6 (IQR 4–8)), neither agreement nor consensus on the relevance could be reached (Fig. 1(a)). There was a high degree of agreement that all the listed foreign materials (with no signs of infection), except for coronary artery stents (5 (IQR 2–7)), define
Discussion
Our survey shows that there was good agreement among the experts on the majority of questions concerning the management of patients with SAB, but there are still important issues where the experts' assessments differed widely. Most notably, no preferred antibiotic could be identified for oral stepdown therapy, most probably due to the lack of good evidence on this topic [3]. It is also worth noting that prostheses were not considered highly relevant for the classification of an SAB episode;
Conclusion
The Delphi survey can help physicians in their day-to-day decision-making process, and it reveals open questions that must be investigated in further studies. However, it must be acknowledged that these expert statements do not claim to be correct, nor should consensus imply that these practices should be medicolegally binding.
Transparency declaration
SH and SW received honoraria for presentations from InfectoPharm. MP received honoraria for presentations from MSD, Novartis, and Pfizer and a research grant from InfectoPharm. All other authors declare that they have no conflicts of interest.
No funding was received for this work.
Author contributions
All authors were involved in the design of the trial. SW and SH were involved in the statistical analyses. SH wrote the original draft of the manuscript. All authors contributed to refinement of and approved this manuscript. All authors had full access to all the data in the study and had final responsibility for the decision to submit for publication. SW, SH, MP, CB also participated in the survey.
Acknowledgements
We thank the expert panel members who participated in the Delphi Rand study for their valuable contribution: Jesus Rodriguez-Bano (Infectious Diseases Division, Hospital Universitario Virgen Macarena, Seville, Spain), Florian Thalhammer (Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University Vienna, Austria), Luis E. López-Cortés (Clinical Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital, Seville, Spain), Annelies
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