Impact of specialty on the self-reported practice of using oral antibiotic therapy for definitive treatment of bloodstream infections

Jasmine R Marcelin; Mackenzie R Keintz; Jihyun Ma; Trevor C Van Schooneveld; Bryan T Alexander; Scott J Bergman; Molly M Miller; Erica J Stohs

doi:10.1017/ash.2023.132

Impact of specialty on the self-reported practice of using oral antibiotic therapy for definitive treatment of bloodstream infections

Antimicrob Steward Healthc Epidemiol. 2023 Mar 9;3(1):e48. doi: 10.1017/ash.2023.132. eCollection 2023.

Authors

Jasmine R Marcelin¹, Mackenzie R Keintz¹, Jihyun Ma², Trevor C Van Schooneveld¹, Bryan T Alexander³, Scott J Bergman^{3

4}, Molly M Miller³, Erica J Stohs¹

Affiliations

¹ Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska.
² Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska.
³ Department of Pharmaceutical and Nutrition Care, Nebraska Medicine, Omaha, Nebraska.
⁴ College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska.

Abstract

Background: No established guidelines exist regarding the role of oral antibiotic therapy (OAT) to treat bloodstream infections (BSIs), and practices may vary depending on clinician specialty and experience.

Objective: To assess practice patterns regarding oral antibiotic use for treatment of bacteremia in infectious diseases clinicians (IDCs, including physicians and pharmacists and trainees in these groups) and non-infectious diseases clinicians (NIDCs).

Design: Open-access survey.

Participants: Clinicians caring for hospitalized patients receiving antibiotics.

Methods: An open-access, web-based survey was distributed to clinicians at a Midwestern academic medical center using e-mail and to clinicians outside the medical center using social media. Respondents answered questions regarding confidence prescribing OAT for BSI in different scenarios. We used χ2 analysis for categorical data evaluated association between responses and demographic groups.

Results: Of 282 survey responses, 82.6% of respondents were physicians, 17.4% pharmacists, and IDCs represented 69.2% of all respondents. IDCs were more likely to select routine use of OAT for BSI due to gram-negative anaerobes (84.6% vs 59.8%; P < .0001), Klebsiella spp (84.5% vs 69.0%; P < .009), Proteus spp (83.6% vs 71.3%; P < .027), and other Enterobacterales (79.5% vs 60.9%; P < .004). Our survey results revealed significant differences in selected treatment of Staphylococcus aureus syndromes. Fewer IDCs than NIDCs selected OAT to complete treatment for methicillin-resistant S. aureus (MRSA) BSI due to gluteal abscess (11.9% vs 25.6%; P = .012) and methicillin-susceptible S. aureus (MSSA) BSI due to septic arthritis (13.9% vs 20.9%; P = .219).

Conclusions: Practice variation and discordance with evidence for the use of OAT for BSIs exists among IDCs versus NIDCs, highlighting opportunities for education in both clinician groups.