School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia.
Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Australia.
Eur J Clin Microbiol Infect Dis. 2018 Mar;37(3):469-474. doi: 10.1007/s10096-018-3192-z. Epub 2018 Jan 22.
The objective of this investigation was to assess whether between-hospital variation in echocardiography usage for patients with Staphylococcus aureus bacteraemia (SAB) is explained by differences in patients' pre-test probability of endocarditis. This was a retrospective cohort study at three neighbouring hospitals in Australia. Consecutive episodes of SAB were reviewed for the presence of three endocarditis risk factors (community onset, prolonged bacteraemia and the presence of an intracardiac prosthetic device) and the performance and results of all echocardiography studies within 30 days. Multivariate logistic regression was used to examine the effect of hospital site on the performance of (i) transoesophageal and (ii) transthoracic echocardiography controlling for major endocarditis risk factors. Significant variation in echocardiography usage was demonstrated between sites in a total cohort of 1167 episodes of SAB. None of the three sites were found to exhibit echocardiography usage that could be considered consistent with current guidelines, and each differed from the guidelines in different ways. Hospital site, rather than endocarditis risk factors, was the strongest predictor of transthoracic echocardiography use; however, the use of transoesophageal echocardiography was strongly predicted by endocarditis risk factors. Variation in echocardiography use between these hospitals is not adequately explained by differences in the risk factor profile of their SAB cohorts.
本研究旨在评估金黄色葡萄球菌菌血症（SAB）患者之间在超声心动图使用方面的医院间差异是否可以用患者心内膜炎的术前预测概率的差异来解释。这是在澳大利亚三家相邻医院进行的回顾性队列研究。对连续发生的 SAB 病例进行了三种心内膜炎风险因素（社区发病、菌血症延长和心内假体存在）的存在情况以及所有 30 天内进行的超声心动图检查的表现和结果进行了审查。多变量逻辑回归用于检查医院地点对（i）经食管和（ii）经胸超声心动图表现的影响，控制主要心内膜炎风险因素。在总共 1167 例 SAB 患者的队列中，观察到超声心动图使用方面存在显著的医院间差异。这三个部位均未发现超声心动图的使用符合当前指南，每个部位的使用方式都与指南有所不同。医院地点而非心内膜炎风险因素是经胸超声心动图使用的最强预测因素；然而，经食管超声心动图的使用则强烈受到心内膜炎风险因素的预测。这些医院之间的超声心动图使用差异不能用其 SAB 队列的风险因素特征差异来充分解释。
