117 Global differences in SAB management 6 Treatment duration The most commonly identified durations of therapy between geographic regions for SAB-associated syndromes were similar. Thus, the majority of respondents from each continent indicated the same duration of treatment for native valve endocarditis (6 weeks), septic arthritis (4 weeks), and spondylodiscitis (6 weeks). Despite these similarities in practice amongst the majority of practitioners across geographic regions, substantial “within-region” variation existed for these syndromes. For each infectious complication of SAB, individual respondents within each continent indicated longer and shorter durations of therapy (Figure 4). The finding of blood cultures positive for S. aureus after 48–72 hours of appropriate therapy was identified as the most important reason to extend therapy duration in SAB patients beyond 2 weeks in all continents (range: 66% in South America to 90% in North America). Immunocompromised status was identified as an indication to extend antibiotic treatment beyond 2 weeks for most North American physicians (72%) but less than half (43%) of European physicians. By contrast, community acquisition of SAB was considered a reason to extend antibiotic treatment in only 20%–41% of physicians (Table 1; P < .01 for all above mentioned comparisons between continents). 18F-FDG PET/CT scan use The availability, insurance coverage, and use of 18F-FDG PET/CT scans differed significantly between geographic regions (Table 1). All were highest in Europe and lowest in Africa. The direct availability of 18F-FDG PET/CT scans for SAB patients ranged from 9% in Africa and 29% in South America, to 78% in Europe. 18F-FDG PET/CT scans were used for SAB patients by 94% of European, 83% of Oceanian, 61% of South American, 57% of Asian, and 51% of North American physicians (P < .01 for both above mentioned comparisons between continents). Survey respondents indicating that they ordered 18F-FDG PET/CT scans in patients with SAB were asked to specify for which indications they did so. Globally, the most important and most agreed upon indication for 18F-FDG PET/CT scan in SAB was persistent bacteremia: 62%–70% of physicians in every continent ordered 18F-FDG PET/CT scans for this indication (Supplementary Table 2; P = .66). Persistent S. aureus bacteremia The clinical definition of persistent SAB varied widely between continents. The most frequent definition of persistent SAB was a duration of at least 3-4 days of positive blood cultures despite appropriate treatment, identified by >33% of physicians in every continent. However, in Europe (31%) and South America (24%), a significant
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