846. Compliance with  Staphylococcus aureus Bacteremia Quality-of-care Guidelines
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 9, 2015
Room: Poster Hall
Posters
  • 150SAB Graph 84-42.jpg (10.0 MB)
  • Background: Staphylococcus  aureus  bacteremia ( SAB)  is  associated  with  significant mortality.  Studies  have  shown  a  reduction  in  mortality  when  a  bundle  of  interventions (quality-indicators)  were  used  as  standards  of  care  for  SAB.  These  quality  indicators  include  performing  follow-up  blood  cultures,  echocardiography,  source  control,  use  of  appropriate  antibiotics,  monitoring  vancomycin  levels  and  appropriate  duration  of  antibiotics.  Studies  have  shown  the  impact  of  consultation  by  an  Infectious  Diseases( ID) physician  on  adherence  to  these  quality  indicators.  The  purpose  of  our  study  was  to compare  the  adherence with  SAB quality-of-care  indicators,  crude  and  attributable  mortality  between  patients  who  received  ID  consultation  versus  those  who  did  not. 

    Methods: After  approval  from  the  Institutional  Review  board,  a retrospective  chart  review  was  performed  on  160  patients  who  were  diagnosed  with  SAB  between  July  to  December  2013.   Patients  who  were  discharged  or  died  within  48  hours  after  admission  were  excluded  from  the  study.  Extracted  data  included  follow-up  blood  cultures,  echocardiography,  presence  of  focal  source  of  infection,  use  of  appropriate antibiotic, measurement  of  vancomycin  levels,  duration  of  therapy,  death  during  hospitalization  and presence  of  an  ID  consultation.  Chi  square,  Fischer  exact   tests  and  non parametric  Wilcoxon  rank  sum  test  were  used  to  analyze  categorical  and  continuous  variables,  respectively. 

    Results: A total  of  153  patients  were included in the analysis.  Significant  differences  were  noted  in  adherence  to  performing   follow  up  blood  cultures (91% vs 63%, p=0.0001), performing echocardiography (95% vs 63%, p<0.001),  duration  of  antibiotic  therapy ( 33.5 vs 18 days , p<0.0001) in  those  who  received  ID consultation  vs  those  who  did  not.  Mortality  was  lower  in  patients  receiving  ID  consultation (8.9% vs 20%, p=0.0840),  although difference  was  not  statistically  significant.  However,  there  was  no  statistical  difference  in  attributable  mortality. 

    Conclusion:   Infectious  Disease  consultation  improved  adherence  to  some  quality  indicators  for  SAB ,  with  a  trend  towards  improved  mortality.   Hospital  systems  should  consider mandatory  ID  consultation  for  patients  with  SAB.

    Niyati Narsana, MD, Internal Medicine, Medstar Washington Hospital Center, Washington, DC, Kristin Mills, MD, Infectious Diseases, Medstar Washington Hospital Center, Washington, DC and Glenn Wortmann, MD, FIDSA, Infectious Diseases, Infectious Diseases Section, MedStar Washington Hospital Center, Washington DC, DC

    Disclosures:

    N. Narsana, None

    K. Mills, None

    G. Wortmann, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.