title: Feedback to clinicians on preventable factors can reduce hospital onset Staphylococcus aureus bacteraemia rates.
abstract: Staphylococcus aureus bacteraemia (SAB) is associated with significant morbidity and mortality, yet there are limited data on preventable factors. This study aimed to evaluate SAB episodes at a tertiary care hospital; to identify factors that, if avoided, might have prevented the episode of SAB; and to provide feedback to treating clinicians. Of 187 episodes of SAB over 19 months 59.9% were caused by meticillin-susceptible S. aureus (MSSA) and 40.1% meticillin-resistant S. aureus (MRSA), 65.8% of SAB were healthcare-associated (HA) and 34.2% were community-acquired. Seven- and 30-day mortality rates, overall, were 11.2% and 20.9% respectively. At least one preventable factor was identified in 50.4% of HA-SAB episodes, including recent nosocomial MRSA acquisition in 53.7% MRSAB episodes and one or more factors associated with intravenous access in at least 24.3% of HA (35.7% of hospital onset) cases. SAB was more likely to be associated with at least one identifiable, preventable factor in surgical than in medical inpatients (86.2% vs 54.5%, P=0.004). Patients with HA-MRSAB were more likely than those with HA-MSSAB to require intensive care unit admission (44.4% vs 18.8%, P=0.003). Identifying and addressing preventable factors will better target resources for prevention of SAB. Feedback about preventable factors was associated with a reduction in HA-SAB rates from 0.29 to 0.20 per 1000 occupied bed-days, from 2008 to 2009.
authors: Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, New South Wales, Australia. jen.kok@swahs.health.nsw.gov.au
authors: J
authors: J
authors: Kok
authors: M V
authors: MV
authors: O'Sullivan
authors: G L
authors: GL
authors: Gilbert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002406:Catheterization, Peripheral / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008712:Methicillin / Q000494:pharmacology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D008712:Methicillin