113 Global differences in SAB management 6 Introduction Staphylococcus aureus is the leading cause of mortality by bloodstream infections worldwide [1], and methicillin resistant S. aureus (MRSA) is the leading cause of mortality attributable to antimicrobial resistance [2]. Despite its global distribution and an incidence of approximately 30 per 100 000 person-years [3, 4], the optimal approach to S. aureus bacteremia (SAB) is poorly understood. Despite the fact that SAB has been a major theme in the medical literature for decades, basic treatment elements such as the optimal antibiotic regimen, the role of adjunct and oral antibiotics, the optimal treatment duration, and the definition of persistent SAB remain fundamentally unknown. Even less is known about global differences in treatment practices for SAB. The aim of this study was to identify global variation in management, diagnostics, and definitions of SAB. To do this, we used a variety of social media platforms to reach a large number of clinicians throughout the world for a survey on SAB treatment practices. Methods Survey development and distribution We conducted this study on geographic practice variation in SAB by modifying a recently developed survey that was deployed in five European countries [5]. The modified survey was tested among an independent expert panel and adjusted where appropriate. The survey focused on unsettled aspects of the disease in clinical practice: first-choice antimicrobial agents, intravenous to oral switch of antimicrobial therapy, treatment duration, the use of 18F-fluoro-deoxyglucose positron emission tomography/computed tomography (PET/CT) (18F-FDG PET/CT) scan, and the definition of persistent SAB (Supplementary Appendix 1). When relevant, questions were provided separately for both methicillin-susceptible S. aureus (MSSA) and MRSA bacteremia. The survey was anonymous and voluntary. Country of practice was asked to determine geographic region and subsequently respondents were grouped by continent. The survey was developed in English. Target respondents included infectious diseases, clinical microbiology and internal medicine physicians (both adults and pediatrics) treating SAB patients throughout the world. The survey was distributed through a public URL link on listservs, e-mails, Twitter, and WeChat. Respondents were asked to share the survey link with their professional network. The link was accessible between 2 November and 22 November 2022.
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