. 2019 Aug 8;74(11):3344–3351. doi: 10.1093/jac/dkz342

Table 2.

Final list of 25 QIs and 10 associated DCs for the management of patients with SAB

QI	DC	Reference
Blood cultures
QI 1. Follow-up blood cultures after initiation of antimicrobial therapy should be done regardless of clinical evolution.	The optimal time to obtain the first follow-up blood cultures after initiation of antimicrobial therapy is after 48 h.	¹⁷
QI 2. Collection of repeat blood cultures should be performed until first negative blood culture.	The optimal interval to obtain repeat blood cultures is after 48 h.	¹⁵ ^, ¹⁶ ^, ¹⁸ ^, ¹⁹ ^, ²¹ ^, ²² ^, ²⁴ ^, ²⁵
Echocardiography
QI 3. Transthoracic echocardiography should be performed in patients with predisposing cardiac conditions for endocarditis.^a	The optimal time to perform transthoracic echocardiography in patients with SAB and predisposing cardiac conditions for endocarditis is preferably at 3–5 days, but not later than 14 days.	¹⁷ ^, ¹⁹ ^, ²⁴ ^, ²⁵
QI 4. Transthoracic echocardiography should be performed in patients with risk factors for complicated SAB.^a^,b	The optimal time to perform transthoracic echocardiography in patients with risk factors for complicated SAB is preferably at 3–5 days, but not later than 14 days.	¹⁷ ^, ¹⁹ ^, ²⁴ ^, ²⁵
QI 5. Transthoracic echocardiography should be performed in patients with diagnosed complicated SAB.^a^,c	The optimal time to perform transthoracic echocardiography in patients with diagnosed complicated SAB is preferably as soon as possible, but not later than 72 h after first positive blood culture	¹⁷ ^, ¹⁹ ^, ²⁴ ^, ²⁵
QI 6. Transoesophageal echocardiography should be performed in patients with SAB and predisposing cardiac conditions for endocarditis.	The optimal time to perform transoesophageal echocardiography in patients with SAB and predisposing cardiac conditions for endocarditis is preferably at 3–5 days, but not later than 14 days.	¹⁷ ^, ¹⁹ ^, ²⁴ ^, ²⁵
QI 7. Transoesophageal echocardiography should be performed in patients with risk factors for complicated SAB.^b	The optimal time to perform transoesophageal echocardiography in patients with risk factors for complicated SAB is preferably at 3–5 days, but not later than 14 days.	¹⁷ ^, ¹⁹ ^, ²⁴ ^, ²⁵
QI 8. Transoesophageal echocardiography should be performed in patients with diagnosed complicated SAB.^c	The optimal time to perform transoesophageal echocardiography in patients with diagnosed complicated SAB is preferably as soon as possible, but not later than 72 h after first positive blood culture.	¹⁷ ^, ¹⁹ ^, ²⁴ ^, ²⁵
Non-antibiotic therapeutic interventions
QI 9. After detection of SAB a vascular catheter should always be removed.	The optimal time of removal of vascular catheter after detection of SAB is right away and at least within 24 h.	¹⁵ ^, ^17–19 ^, ^23–25
QI 10. Cardiovascular implantable electronic devices should be removed when these devices are confirmed to be infected in patients with SAB.		¹⁵ ^, ²¹ ^, ²³
QI 11. A joint prosthesis should undergo debridement and/or should be surgically removed when the joint prosthesis is confirmed to be infected in patients with SAB.		²¹ ^, ²³
QI 12. An abscess should be drained in patients with SAB.	The optimal time of drainage of an abscess in patients with SAB is within 24 h.	¹⁷ ^, ¹⁹ ^, ²³
Antibiotic treatment
QI 13. Initial antibiotic therapy should be administered intravenously in patients with SAB.		¹⁴ ^, ¹⁵ ^, ^17–19 ^, ²³ ^, ²⁴
QI 14. Initial therapy should be intravenous (flu)cloxacillin (or nafcillin or oxacillin) or cefazolin in the case of methicillin-susceptible strains in patients with SAB.		^15–17 ^, ¹⁹ ^, ^22–25
QI 15. Antibiotic therapy should be initiated within 24 h after first positive blood culture.		²² ^, ²³
QI 16. Appropriate treatment should be adapted within the first 24 h after a methicillin susceptibility result is available, if so required.		¹⁵ ^, ¹⁷ ^, ²¹
QI 17. The dosage of antibiotic treatment should be according to (national) guidelines in patients with SAB.		¹¹
QI 18. Appropriate duration of intravenous antibiotic treatment should be at least 14 days for uncomplicated SAB.		⁴ ^, ¹⁵ ^, ^17–19 ^, ²¹ ^, ^23–25
QI 19. Appropriate duration of intravenous antibiotic treatment should be at least 28 days for SAB complicated by metastatic abscesses or deep foci of infection.^d		¹⁵ ^, ^17–19 ^, ^23–25
QI 20. Therapeutic drug monitoring should be performed when SAB is treated with vancomycin.		¹⁶ ^, ¹⁷ ^, ¹⁹ ^, ²²
QI 21. Antibiotic treatment therapy for patients with SAB should be adjusted according renal function.		¹¹
QI 22. Intravenous-to-oral switch should not be performed in uncomplicated SAB after 48–72 h.		¹⁴
QI 23. Intravenous-to-oral switch should not be performed in complicated SAB after 48–72 h.		¹⁴
Other management aspects
QI 24. Infectious disease specialist consultation should be performed in patients with SAB.		⁴ ^, ¹⁵ ^, ^20–22 ^, ²⁴ ^, ²⁵
QI 25. SAB should be documented in the medical discharge summary.		¹⁸

The performance of a transoesophageal echocardiography as first-line diagnostic modality obviates the need for transthoracic echocardiography.

Patients with one of the following: community acquisition, signs of infection >48 h before initiation of appropriate treatment, fever >72 h after initiation of appropriate treatment, and/or positive blood cultures >48 h after initiation of appropriate treatment.

Uncomplicated bacteraemia: exclusion of endocarditis and other metastatic sites of infection, the absence of implanted prostheses, clearance of bacteraemia within 4 days for patients with repeat blood cultures, and defervescence within 72 h after the initiation of effective therapy. Complicated bacteraemia: cases not meeting the criteria for uncomplicated bacteraemia.

Patients with endocarditis are not included.