Bridging the gap in bloodstream infection management: a survey among non-infectious disease physicians

Bloodstream infections (BSIs) significantly impact morbidity and mortality. Despite emerging evidence supporting optimal management, substantial variability persists among non-infectious disease (ID) physicians. This study assessed non-ID physicians' knowledge and attitudes in BSI management, identifying critical gaps to inform antimicrobial stewardship (AMS) interventions.

In December 2024, we conducted an online questionnaire among non-ID physicians at the Provincial Health Care Agency, Trento, Italy. An 18-item questionnaire, developed by a multidisciplinary group, evaluated key domains of BSI management, including diagnostic strategies, antibiotic selection, treatment duration, follow-up management, and ID consultation practices. Descriptive statistics were used to analyse response patterns.

Of 128 respondents, 99% expressed willingness to follow internal BSI guidelines, and 94% supported multidisciplinary feedback. Overall, 50.8% correctly identified the optimal 14-day antibiotic duration for uncomplicated Staphylococcus aureus bacteraemia (SAB), and 67.2% selected appropriate treatment for MSSA infections. The prevalence of complicated SAB was underestimated by 51.6% of participants. Follow-up blood cultures and echocardiography were variably recommended (40.6% and 71.9%, respectively, for SAB). 50.8% correctly indicated a 7-day therapy for uncomplicated Gram-negative BSIs, and 49.2% appropriately chose first-line treatments for susceptible Enterobacterales. Familiarity with antibiotic de-escalation (86.7%) and IV-to-oral therapy (94.5%) was high, but appropriate application knowledge was inconsistent. Penicillin safety in reported low-risk allergies was recognized by 63.3%, and carbapenems as alternatives by 46.1%.

These findings highlights substantial knowledge gaps among non-ID physicians regarding bacterial BSI management. These findings support targeted AMS interventions under the Bacteraemia Evidence-based Active Treatment (BEAT) initiative to improve clinical outcomes.