Usefulness of the CPG in the management of severe S. aureus infections

Staphylococcus aureus bacteremia (SAB) is not only an indicaor of infection control performance in healthcare institutions. Its ncidence per admission particularly when counting nosocomial nd community-onset healthcare-associated cases can be used for nfection control quality assessment, and this has been done so in ustralian hospitals, for example.1,2 SAB outcomes also are a proxy easure of infection management quality in healthcare instituions. The disease is frequent and (too) frequently lethal.3 It requires uch of our coordinated and interdisciplinary skills and efforts o provide best-available infection management and to improve atient care and safety. In fact, only with intensive diagnostic workp including imaging and microbiological testing, interdisciplinary iscussion, timely surgical interventions if indicated and feasible, linical monitoring and individualized antimicrobial drug therapy dapted to findings usually available only after several days will it e possible to significantly improving outcomes. To make it therefore short here: my disappointment with this ew SEIMC guidance document4 is that infectious disease consulation has not been given a level A recommendation. In my view, he evidence from the literature in the sense of improved survival f SAB patients after infectious disease consultation is immense lthough not being first-class evidence and coming “only” from bservational and quasiexperimental studies rather than randomzed trials. Recent additions to the field from multicenter trials onfirm many single-center observations and clearly demonstrate survival benefit after infectious disease consultation.5,6 The SEIMC ocument authors have consented and offer quite a lot of level A ecommendations (I counted 28) of which most again were not lass I evidence, but class II and even class III! So, why not scoring he infectious disease consultation recommendation level A if this as reproducibly been associated with improved survival in many tudies in different settings? What more is needed for an upgrade