126 Chapter 6 Perspective The current study suggests that there is no global standard of practice for SAB. Striking differences were noted, both between and within continents, in what antibiotics were prescribed, and by what route. The lack of a global standard in the management of SAB stands in stark contrast to treatment of other syndromes of comparable lethality. For coronary artery disease, management has been largely standardized by guidelines based on data from randomized controlled trials [23–25]. Coincident with establishing these best treatment practices, the annual US mortality rate from coronary artery disease declined by 17.7% from 2005 to 2015 [26]. By contrast, the 1-month mortality for patients with SAB only decreased by 2.8% over the same time period [27]. The results of this study underscore one key fact: a global standard of care for SAB will be difficult to develop pending more definitive clinical trials data. Indeed, fewer than 3500 patients have been enrolled in published SAB randomized trials over the past 20 years (Supplementary Table 3). Factors other than robust clinical data, such as cultural differences, costs and availability of resources also influence management choices. However, without consensus on best practice, normative and cultural factors gain influence on for example antibiotic prescription behavior [28]. Multinational clinical trials such as the Staphylococcus aureus Network Adaptive Platform (SNAP) [13] are thus essential to standardize clinical definitions, identify treatment strategies, and improve patient outcomes of this common and frequently lethal infection. Strengths and limitations The current study illustrates the potential of using social media to understand global treatment practices and decision making. Although previous studies on physicians’ management of SAB have been conducted [5, 29, 30], none were as extensive and on a global scale as this current study. Our study has several limitations. There were relatively low participation rates from South America and Africa. The respondents were not questioned about their local guideline and adherence to it, and for many countries no national guidelines were available. This made it impossible for us to consider the role of national guidelines in the present study. Given the fact that 71 countries were included in the survey, comparing differences between each of these countries was methodologically infeasible. Therefore, we limited the analyses to continents. We were unable to evaluate spatial clustering of infections. The survey was only available in English, which might have dissuaded non-English speaking physicians. Because the survey was distributed through listservs and social media, the exact number of recipients or proportion of physicians per country is unknown. Therefore, the true response rate is uncertain and could only be estimated by the ratio of the reported surveys and the number of times the URL link was opened.
RkJQdWJsaXNoZXIy MTk4NDMw