Survey of Physicians’ Perspectives and Knowledge about Diagnostic Tests for Bloodstream Infections

<div><p>Background</p><p>Physicians rely on blood culture to diagnose bloodstream infections (BSI) despite its limitations. As new technologies emerge for rapid BSI diagnosis, optimization of their application to patient care requires an understanding of clinicians’ perspectives on BSI diagnosis and how a rapid test would influence medical decisions.</p><p>Methods</p><p>We administered a 26-question survey to practitioners in infectious diseases/microbiology, critical care, internal medicine, and hematology/oncology services in USA and Germany about current standards in diagnosing and treating BSI and a hypothetical rapid BSI test.</p><p>Results</p><p>Responses from 242 providers had roughly equal representation across specialties. For suspected BSI patients, 78% of practitioners would administer empiric broad spectrum antibiotics although they estimated, on average, that 31% of patients received incorrect antibiotics while awaiting blood culture results. The ability of blood culture to rule in or rule out infection was very/extremely acceptable in 67% and 36%, respectively. Given rapid test results, 60–87% of practitioners would narrow the spectrum of antimicrobial therapy depending on the microorganism detected, with significantly higher percentages when resistance determinants were also tested. Over half of respondents felt a rapid test would be very/extremely influential on clinical practice.</p><p>Conclusions</p><p>Limitations of blood culture were perceived as a barrier to patient care. A rapid test to diagnose BSI would impact clinical practice, but the extent of impact may be limited by prevailing attitudes and practices. Opportunities exist for interventions to influence practitioners’ behaviors in BSI management particularly with emergence of newer diagnostic tests.</p></div

Influence of test results on antimicrobial therapy.

<p>Shown in Panel A are the percentages of respondents that would narrow empirical antimicrobial therapy based on rapid test identification result is shown. Panel B displays the percentage of respondents that would change empirical antimicrobial therapy based on rapid test identification result if preliminary susceptibility results were included.</p

Practitioners’ Perceptions of Blood Culture Performance—Number and Percentage Finding Metric Extremely or Very Acceptable on 5-point Likert Scale.

<p>Practitioners’ Perceptions of Blood Culture Performance—Number and Percentage Finding Metric Extremely or Very Acceptable on 5-point Likert Scale.</p

Percentage of practitioners that would administer empirical therapy stratified by patient risk for BSI (Q10).

<p>Mean values are shown with one standard deviation error bars.</p

Practitioner Perceptions of Hypothetical Rapid Test on Clinical Practice—Number and Percentage Finding Test Very/Extremely Influential on 5-point Likert Scale.

<p>Practitioner Perceptions of Hypothetical Rapid Test on Clinical Practice—Number and Percentage Finding Test Very/Extremely Influential on 5-point Likert Scale.</p