Impact of an evidence-based bundle intervention in the quality-of-care management and outcome of Staphylococcus aureus bacteremia.
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. The objective of the study was to identify evidence-based quality-of-care indicators (QCIs) for the management of SAB, and to evaluate the impact of a QCI-based bundle on the management and prognosis of SAB.


METHODS
A systematic review of the literature to identify QCIs in the management of SAB was performed. Then, the impact of a bundle including selected QCIs was evaluated in a quasi-experimental study in 12 tertiary Spanish hospitals. The main and secondary outcome variables were adherence to QCIs and mortality. Specific structured individualized written recommendations on 6 selected evidence-based QCIs for the management of SAB were provided.


RESULTS
A total of 287 and 221 patients were included in the preintervention and intervention periods, respectively. After controlling for potential confounders, the intervention was independently associated with improved adherence to follow-up blood cultures (odds ratio [OR], 2.83; 95% confidence interval [CI], 1.78-4.49), early source control (OR, 4.56; 95% CI, 2.12-9.79), early intravenous cloxacillin for methicillin-susceptible isolates (OR, 1.79; 95% CI, 1.15-2.78), and appropriate duration of therapy (OR, 2.13; 95% CI, 1.24-3.64). The intervention was independently associated with a decrease in 14-day and 30-day mortality (OR, 0.47; 95% CI, .26-.85 and OR, 0.56; 95% CI, .34-.93, respectively).


CONCLUSIONS
A bundle orientated to improving adherence to evidence-based QCIs improved the management of patients with SAB and was associated with reduced mortality.
Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla.
Luis E
LE
López-Cortés
Maria Dolores
MD
Del Toro
Juan
J
Gálvez-Acebal
Elena
E
Bereciartua-Bastarrica
María Carmen
MC
Fariñas
Mercedes
M
Sanz-Franco
Clara
C
Natera
Juan E
JE
Corzo
José Manuel
JM
Lomas
Juan
J
Pasquau
Alfonso
A
Del Arco
María Paz
MP
Martínez
Alberto
A
Romero
Miguel A
MA
Muniain
Marina
M
de Cueto
Alvaro
A
Pascual
Jesús
J
Rodríguez-Baño
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D019090:Case Management; D019983:Guideline Adherence; D006801:Humans; D013030:Spain; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D016019:Survival Analysis; D062606:Tertiary Care Centers; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents
Staphylococcus aureus; bacteremia; bloodstream infections; clinical management; intervention