Background: Methicillin Resistant Staphylococcus aureus (MRSA) continues to be a significant cause of healthcare associated infections and is associated with significant mortality and morbidity. There are increasing concerns regarding compliance with evidence based guidelines for management of MRSA infections, and prompts integrated into Electronic Medical Records (EMR) might be of benefit.
Methods: We performed a retrospective cohort study of all hospitalized patients with a positive blood culture for MRSA during the 3-year period between January 2012 and December 2014 at a community-based academic medical center. Using the Infectious Disease Society of America clinical practice guidelines as the presumed gold standard, we assessed clinical management and outcomes in patients with and without an infectious disease consultation (IDC) using a bivariate analysis.
Results: Two hundred and seventeen MRSA bacteremias occurred in 112 patients, of which 127 were new bacteremias. Forty-two (33%) of these 127 cases had an IDC during their hospitalization. Evaluation by echocardiogram (93% vs 69.3%, p=0.004) and follow up blood cultures (97.6% vs 75.3%, p=0.002) were performed more often in patients with an IDC. A more thorough assessment to identify the source of infection (92.9% vs 61.7%, p<0.001) was performed and a more appropriate antibiotic (100% vs 77.2% p <0.001) was prescribed in patients with an IDC. Six-month readmission rates were lower in patients with an IDC, but 30-day mortality was no different in the two groups. Almost a quarter of patients without an IDC (23%) were inappropriately treated. Of these, 6 were treated with oral trimethoprim-sulfamethoxazole, 6 with linezolid, while 4 received no medical treatment for MRSA bacteremia.
Conclusion: The compliance of general internists and surgeons at our academic center with evidence based guidelines for management of MRSA bacteremia was better than previously reported studies, but still needs to be improved. IDC helped guide comprehensive evaluation, appropriate antibiotic selection, adequate duration of therapy, and improved some clinical outcomes. Bundle management with decision support tools built into the electronic medical records and/or IDC may improve physician compliance with clinical practice guidelines.
J. Halanych, None
B. Camins, Astellas: Investigator , Grant recipient