Staphylococcus aureus is a leading cause of bacteremias with a high attributable mortality. Standardized care for SAB includes: repeated blood cultures, removal of infectious foci, echocardiography, early appropriate antibiotics and adequate duration of therapy. The aim of this study was to assess the adequacy of SAB management at our institution and identify opportunities for improvement through coordinated interventions.
A retrospective, observational study was conducted to evaluate adult patients with documented SAB between January 1, 2015 and December 31, 2015. A standardized data collection sheet was utilized to abstract six core measures including: surveillance blood cultures, source control, echocardiography, early nafcillin use in methicillin susceptible Staphylococcus aureus (MSSA), vancomycin dosing and treatment duration. Patients were stratified into two cohorts: infectious diseases consultation and non-infectious diseases consultation.
Seventy six patients with SAB were included in the analysis. Thirty-eight percent of cultures of SAB were methicillin resistant Staphylococcus aureus. Overall, hospital mortality was 9.2%. The most common source for SAB was central venous catheters (26%) followed by skin and soft tissues infections (25%). Eight patients (15%) had complicated SAB. Surveillance blood cultures were obtained in 64 patients (84.2%) and adequate source control was performed in 52 (68.4%) patients. One third of the cohort 27(35,5%) had transesophageal echocardiography (TEE). Nafcillin was administered to 19 (40%) patients with MSSA bacteremia lacking penicillin allergies. Thirty one (40.8%) patients received more than four weeks of antibiotics. Infectious diseases consultation significantly improved the use of core measures for SAB: surveillance blood cultures (96% versus 63%, p- < 0.001), TEE (46.9% vs. 14.8%, p-< 0.006), early targeted antimicrobial therapy with nafcillin in MSSA (34.7% vs. 3.7%, p= 0.002), longer duration of antibiotics (59.2 % vs. 7.4%, p <0.001).
Infectious diseases consultation significantly improved SAB care. Our data suggest that establishing a mandatory consult for SAB bacteremia in our institution will increase compliance with core measures and improved overall quality of care.
N. Law, None
T. Bias, None
S. Schultz, None
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