Clinical variation in the use of echocardiography in Staphylococcus aureus bacteraemia

a multi-centre cohort study

George S. Heriot, Steven Y.C. Tong, Allen C. Cheng, Irani Thevarajan, Michele R. Levinson, Kumar Visvanathan, Danny Liew

Research output: Contribution to journalArticleResearchpeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)469-474
Number of pages6
JournalEuropean Journal of Clinical Microbiology and Infectious Diseases
Volume37
Issue number3
DOIs
Publication statusPublished - Mar 2018

Fingerprint

Bacteremia
Echocardiography
Staphylococcus aureus
Cohort Studies
Endocarditis
Guidelines
Transesophageal Echocardiography
Retrospective Studies
Logistic Models
Equipment and Supplies

Cite this

Heriot, George S. ; Tong, Steven Y.C. ; Cheng, Allen C. ; Thevarajan, Irani ; Levinson, Michele R. ; Visvanathan, Kumar ; Liew, Danny. / Clinical variation in the use of echocardiography in Staphylococcus aureus bacteraemia : a multi-centre cohort study. In: European Journal of Clinical Microbiology and Infectious Diseases. 2018 ; Vol. 37, No. 3. pp. 469-474.
@article{dbe78cf5bb504c50b3be62ca1c951328,
title = "Clinical variation in the use of echocardiography in Staphylococcus aureus bacteraemia: a multi-centre cohort study",
abstract = "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.",
author = "Heriot, {George S.} and Tong, {Steven Y.C.} and Cheng, {Allen C.} and Irani Thevarajan and Levinson, {Michele R.} and Kumar Visvanathan and Danny Liew",
year = "2018",
month = "3",
doi = "10.1007/s10096-018-3192-z",
language = "English",
volume = "37",
pages = "469--474",
journal = "European Journal of Clinical Microbiology and Infectious Diseases",
issn = "0934-9723",
publisher = "Springer",
number = "3",

}

Clinical variation in the use of echocardiography in Staphylococcus aureus bacteraemia : a multi-centre cohort study. / Heriot, George S.; Tong, Steven Y.C.; Cheng, Allen C.; Thevarajan, Irani; Levinson, Michele R.; Visvanathan, Kumar; Liew, Danny.

In: European Journal of Clinical Microbiology and Infectious Diseases, Vol. 37, No. 3, 03.2018, p. 469-474.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Clinical variation in the use of echocardiography in Staphylococcus aureus bacteraemia

T2 - a multi-centre cohort study

AU - Heriot, George S.

AU - Tong, Steven Y.C.

AU - Cheng, Allen C.

AU - Thevarajan, Irani

AU - Levinson, Michele R.

AU - Visvanathan, Kumar

AU - Liew, Danny

PY - 2018/3

Y1 - 2018/3

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85040764984&partnerID=8YFLogxK

U2 - 10.1007/s10096-018-3192-z

DO - 10.1007/s10096-018-3192-z

M3 - Article

VL - 37

SP - 469

EP - 474

JO - European Journal of Clinical Microbiology and Infectious Diseases

JF - European Journal of Clinical Microbiology and Infectious Diseases

SN - 0934-9723

IS - 3

ER -