357. Infectious Diseases consultation improves adherence to IDSA Treatment Guidelines in the Treatment of Staphylococcus aureus bacteremia
Session: Poster Abstract Session: MRSA, MSSA, Enterococci
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDSAposter.pdf (468.0 kB)
  • Background: Staphylococcus aureus bacteremia (SAB) is common and has significant morbidity and mortality. The Infectious Diseases Society of America (IDSA) recommends interventions to improve outcomes in patients with SAB. We measured compliance with IDSA treatment guidelines at UTMB teaching hospitals and determined if Infectious Diseases Consultation (IDC) was associated with better compliance.

    Methods: We performed a retrospective cohort study of 277 hospitalized patients with SAB between January 2010 and June 2012 at University of Texas Medical Branch (UTMB). Data was collected using Redcap, a web based data collection system. Demographic and clinical data on each patient including compliance with each IDSA guideline was determined. The association between clinical compliance and IDC was determined using CHI squared analysis. 

    Results: Rates of compliance with IDSA treatment recommendations were as follows:  blood cultures were repeated within 3 days in 226 patients (82%); an echocardiogram was done in 176 patients (55%); intravenous catheters were removed in 51/63 patients with catheters (81%); intravenous beta-lactam antibiotics were prescribed to 124/149 patients with methicillin sensitive SAB (83%); therapeutic vancomycin levels were never achieved in 37/117 patients with MRSA bacteremia (32%); More than 4 weeks of intravenous antibiotics were prescribed in 51/122 patients with complicated bacteremia (42%); and IDC occurred in 145 cases (52%). IDC was associated with higher compliance rates in documentation of bacteremia clearance (91% vs., 75%, p=0.027), obtaining an echocardiography (83% vs. 42%, p<0.001), follow-up blood cultures (92% vs. 71%, p <0.001), beta-lactam use in methicillin sensitive SAB (94% vs. 70%, p<0.001) and in appropriate length of therapy with complicated bacteremia (76% vs. 31%, p<0.001).

    Conclusion: Overall, there were significant gaps in compliance with IDSA Guidelines for the treatment of SAB at UTMB. Obtaining an Infectious Diseases Consultation was associated with better adherence to the IDSA guidelines.

    Won K. Chung, MD, Infectious Diseases Division, University of Texas Medical Branch, Galveston, TX, Sharon Onguti, MD, Internal Medicine, University of Texas Medical Branch, Galveston, TX, Philip Keiser, MD, utmb, galveston, TX, Sofia Ansari, MD, Infectious Diseases, University of Texas Medical Branch, Galveston, TX and A. Clinton White, University of Texas Medical Branch, Galveston, TX

    Disclosures:

    W. K. Chung, None

    S. Onguti, None

    P. Keiser, None

    S. Ansari, None

    A. C. White, None

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