Staphylococcus aureus bloodstream infection (SAB) is a serious clinical condition and is 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. In this study, we evaluated the management of SAB in our hospital using QCIs and assessed the mortality rate trend of SAB cases over a 9-year period.
SAB cases were retrospectively analyzed from 2006-2014 in a 1120-bed tertiary care university hospital in Kyoto, Japan. A proactive intervention for positive blood cultures was started in 2002 and 5 QCIs similar to those mentioned in a previous report by Lopez-Cortez in CID were implemented, including (1) follow-up blood cultures, (2) early source control when applicable, (3) echocardiography, (4) early use of appropriate antibiotics (i.e., cefazolin for methicillin susceptible (MSSA) isolates and glycopeptides for methicillin resistant (MRSA) isolates), and (5) appropriate duration of therapy. We assessed the adherence rate for QCIs and the trends in 30-day mortality rates through proactive intervention.
There were 547 SAB cases during the study period, of which 236 were MRSA cases (43.2%). The 2006-2008 period consisted of 156 cases, 209 cases from 2009-2011 and 182 cases from the 2012-2014 period, respectively. The proportion of SAB cases adhering to 4 or 5 QCIs increased from 55.1 % in the 2006-2008 period to 62.7% in the 2009-2011 period, subsequently 70.3 % in the 2013-2014 period (P<0.05), whereas 30-day mortality decreased from 17.9% to 12.1%. The difference was apparent in MRSA cases (23.0% vs 11.8%) and the prognosis of MRSA cases eventually became comparable with that of MSSA cases (12.3%) in the 2012-2014 period.
In contrast to the increase in the proportion of SAB cases adhering to QCIs, better prognosis of SAB was observed over a decade of proactive intervention. In addition, the prognosis of MRSA SAB could become as good as MSSA SAB with adequate management.
Y. Matsumura, None
T. Noguchi, None
S. Nakano, None
K. Kato, None
T. Yunoki, None
S. Takakura, None
S. Ichiyama, None