Methods: A retrospective review was conducted on 400 randomly selected patients with SAB, 200 pre- and 200 post-implementation of a four-part management checklist. The primary outcome was overall adherence to the checklist, which included: repeat blood cultures, echocardiography, correct antibiotic/route selection, and appropriate antibiotic duration. Secondary outcomes included adherence when an ID physician was not consulted, adherence to the four components individually, and appropriate imaging.
Results: Adherence to the four part bundle remained stable from 2015 to 2017, with overall adherence rates of 80% and 79%, respectively. From 2015 to 2017, patients without repeat blood cultures (7% vs 2%, respectively) and inappropriate inpatient antibiotic selection (6% vs 3%, respectively) improved. Outpatient prescribing (11% vs 11%), lack of imaging (11% vs 9%), and antibiotic duration (15% vs 15%) were consistent from 2015 to 2017, respectively. In 2017, thirteen patients were discharged on oral antibiotics and were deemed inappropriate per the study criteria, though 12 of these patients were on appropriate antibiotics while inpatient. Infectious diseases providers were consulted on 96% of cases in 2017, an increase from 90% in 2015.
Conclusion: Adherence to an evidence based treatment bundle remains consistent with a previous analysis, despite an increase in cases with an ID provider consulted. Repeating blood cultures and inpatient prescribing improved over the interval. Focus areas for improvement include imaging, outpatient prescribing, and duration of therapy.