125 Global differences in SAB management 6 Broader global consensus existed for treatment duration of SAB. The worldwide similarity of respondents’ views on treatment duration for SAB is noteworthy given that the data for this aspect of SAB is at least as limited as that for the treatmentrelated aspects outlined above for which there is significant controversy [14, 15]. Although the majority of surveyed physicians throughout the world treat complications of SAB such as endocarditis and osteoarticular infection for a similar duration, a portion of physicians in each continent will treat substantially longer or shorter. This finding suggests that factors influencing treatment duration decisionmaking may be provider-based and situational rather than simply geographical in nature. 18F-FDG PET/CT use Our findings also indicate significant geographic variability in the use of 18F-FDG PET/ CT as diagnostic tool in SAB, with broad use in Europe and Oceania being balanced by infrequency in other continents. Observational studies have reported that 18F-FDG PET/CT may impact management and reduce mortality in patients with SAB because of higher detection of metastatic foci [16, 17], although the reduced mortality may have been confounded by immortal time bias related to including patients dying before undergoing 18F-FDG PET/CT [18]. Obviously, the associated costs could be a reason to refrain from using 18F-FDG PET/CT in low- and middle-income regions, but this does not explain its highly variable use in high-income regions. Recently, a call to action was published in the United States, advocating for insurance coverage of 18F-FDG PET/CT use in SAB patients [19]. In order to reach that goal, high-quality studies including randomized trials of 18F-FDG PET/CT are warranted. Definition of persistent SAB The results of our survey suggest that the identification of persistent SAB may be therapeutically important, as it triggers additional diagnostic testing and changes in medical management for the majority of respondents. However, respondents generally disagreed on how to define it. Although 3–4 days was the most common identified definition of persistent SAB overall, all options in the range of 2–7 or more days were selected by respondents from each continent. Roughly one third of European respondents defined persistent SAB as only 2 days of bacteremia, although a similar portion of Asian respondents indicated that it occurred after 7 or more days. The prognostic significance of persistent SAB has been previously demonstrated [20– 22]. Identifying a broadly accepted definition of persistent SAB would thus be helpful to optimize clinical decision-making, as well as to harmonize the terminology used in clinical research.
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