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Moving beyond unsolicited consultation: additional impact of a structured intervention on mortality in Staphylococcus aureus bacteraemia.

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Date

2019

Authors

Perez-Rodriguez, Maria Teresa
Sousa, Adrian
Lopez-Cortes, Luis Eduardo
Martinez-Lamas, Lucia
Val, Nuria
Baroja, Aida
Nodar, Andres
Vasallo, Francisco
Alvarez-Fernandez, Maximiliano
Crespo, Manuel

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Oxford University Press
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Abstract

Some evidence-based bundles have tried to standardize the management of Staphylococcus aureus bacteraemia (SAB) to improve the outcome. The aim of our study was to analyse the additional impact on mortality of a structured intervention in patients with SAB. Compliance with the bundle was evaluated in an ambispective cohort of patients with SAB, which included a retrospective cohort [including patients treated before and after the implementation of a bacteraemia programme (no-BP and BP, respectively)] and a prospective cohort (i-BP), in which an additional specific intervention for bundle application was implemented. Multivariate logistic regression was used to measure the influence of the independent variables including compliance with the bundle on 14 and 30 day crude mortality. A total of 271 adult patients with SAB were included. Mortality was significantly different among the three groups (no-BP, BP and i-BP): mortality at 14 days was 18% versus 7% versus 2%, respectively, P = 0.002; and mortality at 30 days was 20% versus 12% versus 5%, respectively, P = 0.011. The factors associated with 14 and 30 day mortality in multivariable analysis were heart failure (OR = 7.63 and OR = 2.27, respectively), MRSA infection (OR = 4.02 and OR = 4.37, respectively) and persistent bacteraemia (OR = 11.01 and OR = 7.83, respectively); protective factors were catheter-related bacteraemia (OR = 0.16 and OR = 0.19, respectively) and >75% bundle compliance (OR = 0.15 and OR = 0.199, respectively). Time required to perform the intervention and the follow-up was 50 min (IQR 40-55 min) per patient. High-level compliance with a standardized bundle of intervention for management of SAB that requires little time was associated with lower mortality at 14 and 30 days.

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Adult
Aged
Aged, 80 and over
Disease Management
Female
Humans
Male
Methicillin-Resistant Staphylococcus aureus
Middle Aged
Quality Indicators, Health Care
Referral and Consultation
Risk Factors
Staphylococcus aureus

DeCS Terms

Mortalidad
Pacientes
Catéteres
Staphylococcus aureus resistente a Meticilina
Insuficiencia cardíaca
Infecciones

CIE Terms

Keywords

Bacteremia, Evidence-Based Practice, Health Impact Assessment, Odds Ratio, Staphylococcal Infections

Citation

Pérez-Rodríguez MT, Sousa A, López-Cortés LE, Martínez-Lamas L, Val N, Baroja A, et al. Moving beyond unsolicited consultation: additional impact of a structured intervention on mortality in Staphylococcus aureus bacteraemia. J Antimicrob Chemother. 2019 Apr 1;74(4):1101-1107.