Complete adherence to evidence-based quality-of-care indicators for Staphylococcus aureus bacteremia resulted in better prognosis

• Published in: Infection Vol. 45; no. 1; pp. 83 - 91
• Main Authors: Nagao, Miki, Yamamoto, Masaki, Matsumura, Yasufumi, Yokota, Isao, Takakura, Shunji, Teramukai, Satoshi, Ichiyama, Satoshi
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2017; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Bacteremia - diagnosis; Bacteremia - drug therapy; Bacteremia - epidemiology; Bacteremia - mortality; Evidence-Based Practice; Family Medicine; Female; General Practice; Humans; Infectious Diseases; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Original Paper; Patient Care Bundles; Prognosis; Quality of Health Care; Retrospective Studies; Staphylococcal Infections - diagnosis; Staphylococcal Infections - drug therapy; Staphylococcal Infections - epidemiology; Staphylococcal Infections - mortality; Staphylococcus aureus; Bundle; Mortality; Bacteremia; Quality of care; Staphylococcus aureus
• ISSN: 0300-8126; 1439-0973
• DOI: 10.1007/s15010-016-0946-3

Purpose Staphylococcus aureus bacteremia (SAB) is a serious clinical condition associated with high morbidity and mortality. Recent studies have revealed that adherence to evidence-based quality-of-care indicators (QCIs) for the management of SAB could result in reduced mortality. We aimed to determine whether compliance with QCIs was associated with mortality and whether compliance with QCIs predicted the mortality of patients with SAB. Methods In a university hospital in Kyoto, Japan, SAB patients, who survived at least 14 days after positive blood cultures were analyzed from 2006 to 2014 to assess their compliance with QCIs and the trend in mortality. In addition, the predicted mortality, which was stratified by the number of fulfilled QCIs (QCI points), was calculated. In this study, the following five main QCI points were evaluated: (1) follow-up blood cultures; (2) early source control when applicable; (3) echocardiography; (4) the early use of appropriate antibiotics, and (5) the appropriate duration of therapy. Results We identified 477 eligible SAB cases, of which 199 were MRSA cases (41.7 %). The proportion of SAB cases in which the physicians adhered to at least four QCIs increased gradually from 47.5 % in 2006 to 79.3 % in 2014 ( P  = 0.001); whereas, the 30-day mortality decreased from 10.0 to 3.4 % after treatment completion. Conclusions With an increase in the proportion of SAB cases adhering to QCIs, better prognoses were observed for patients with SAB. The QCI points reflected the 30-day mortality.