Impact of an evidence-based bundle intervention in the quality-of-care management and outcome of Staphylococcus aureus bacteremia.
Clin Infect Dis. 2013 Aug 8;
Authors: López-Cortés LE, Del Toro MD, Gálvez-Acebal J, Bereciartua-Bastarrica E, Fariñas MC, Sanz-Franco M, Natera C, Corzo JE, Lomas JM, Pasquau J, Del Arco A, Martínez MP, Romero A, de Cueto M, Pascual A, Rodríguez-Baño J, the REIPI/SAB group
Background. Staphylococcus aureus bacteremia (SAB) is associated with significant morbidity and mortality. Several aspects of clinical management have been shown to have significant impact on prognosis. Methods. A systematic review of the literature to identify quality-of-care indicators (QCI) in the management of SAB was performed. Then, the impact of a bundle including selected QCI was evaluated in a quasi-experimental study in 12 tertiary Spanish hospitals. The objective of the study was to identify evidence-based QCI for the management of SAB, and to evaluate the impact of a bundle based on them on the management and prognosis of SAB. The main and secondary outcome variables were adherence to QCI and mortality. Intervention. Specific structured individualized written recommendations on 6 selected evidence-based QCI for the management of SAB were provided; these included: follow-up blood cultures (BC), early source control (ESC), early intravenous cloxacillin for methicillin-susceptible isolates (IVC), adjustment of vancomycin dose according to trough levels (AVD), echocardiography if indicated (ECHO), and appropriate duration of antimicrobial therapy (AD). Results. 287 and 221 patients were included in the pre-intervention and intervention periods, respectively. After controlling for potential confounders, the intervention was independently associated with improved adherence to BC (OR=2.83; 95% CI: 1.78-4.49), ESC (4.56; 2.12-9.79), EIVC (1.79; 1.15-2.78), and AD (2.13; 1.24-3.64). Also, it was independently associated with a decrease in 14-day and 30-day mortality (0.47; 0.26-0.85, and 0.56; 0.34-0.93, respectively). Conclusions. A bundle orientated to improving adherence to evidence-based QCI improved the management of patients with SAB and was associated with reduced mortality.
PMID: 23929889 [PubMed - as supplied by publisher]