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Performance of processes of care and outcomes in patients with Staphylococcus aureus bacteremia.
J Hosp Med. 2016 Jan;11(1):27-32
Authors: Rosa R, Wawrzyniak A, Sfeir M, Smith L, Abbo LM
Abstract
BACKGROUND: Staphylococcus aureus bacteremia (SAB) is associated with significant morbidity and mortality in hospitalized adults.
OBJECTIVE: We aimed to identify current practice patterns in the management of SAB, and to evaluate their association with clinical outcomes.
DESIGN: Retrospective cohort study.
SETTING: A 1558-bed tertiary care teaching hospital.
PATIENTS: Adult patients hospitalized between January 1, 2012 through April 30, 2013, who had at least 1 positive blood culture with S aureus.
INTERVENTION: None
MEASUREMENTS: Electronic medical records were reviewed and the processes of care in the management of SAB were identified. The main outcome was clinical failure, defined as a composite endpoint of in-hospital mortality and persistent bacteremia.
RESULTS: Two hundred fifty episodes of SAB occurred in 241 patients, and 78 (32.4%) had clinical failure. Processes of care that impacted the risk of clinical failure included: timing of follow-up blood cultures (delays of >4 days had a relative risk [RR] of 6.6; 95% confidence interval [CI]: 2.1-20.5; P = 0.001), consultation with infectious diseases specialist within 6 days from diagnosis of SAB (RR: 0.3; 95% CI: 0.1-0.9; P = 0.03), and use of β-lactams in patients with methicillin-susceptible S aureus bacteremia (RR: 0.1; 95% CI: 0.04-0.5; P = 0.002).
CONCLUSIONS: The processes of care identified in our study could serve as quality and patient safety indicators for the management of SAB.
PMID: 26381394 [PubMed - indexed for MEDLINE]