Methods: All cultures positive for SAB over 7 months were highlighted in the hospital epidemiology system, and prospectively reviewed by the AST. Recommendations were then provided to the primary care team to 1) obtain ID consult when appropriate, 2) select antibiotics consistent with susceptibilities, 3) obtain repeat blood cultures, and 4) assure adherence to route and duration in accordance with guidelines.
Results: A total of 104 SAB episodes were identified and 92 episodes included. Reasons for exclusion include persistent SAB or treatment prior to admission. Methicillin-resistant SAB accounted for 36% (33/92) of cases; catheter-related (25%) and endovascular (22%) infections were common identified sources. The majority (77%) of patients received an ID consultation. AST recommendations were provided for 12 cases; most were accepted. These comprised escalation (n=3) or de-escalation of antibiotics (n=6), and suggestions for closer monitoring (n=3). Escalation involved changing from inappropriate oral to acceptable intravenous antibiotics, while vancomycin was de-escalated when methicillin-sensitive SAB was reported. Eighty-two cases had follow-up blood cultures within 4 days of SAB, and 89% had echocardiography performed. Where applicable, early source control was obtained for 40% (18/44) of patients. Almost all (90%) received adequate SAB therapy within 24 hours of the initial culture, and 88% received appropriate treatment durations. Appropriate step-down therapy for methicillin-susceptible SAB was noted at more than 95% (43/45). A low in-hospital mortality rate of 6.5% was reported.
Conclusion: Prospective culture review and feedback by the stewardship team, coupled with a high rate for ID consultation, could contribute to good adherence to SAB quality measures and was possibly associated with a low mortality rate.
G. Dumyati, None
P. Graman, None
E. Dodds Ashley, None