Impact of an antimicrobial stewardship-led intervention for Staphylococcus aureus bacteraemia: a quasi-experimental study.
BACKGROUND
Staphylococcus aureus bacteraemia (SAB) carries high rates of morbidity and mortality. Antimicrobial stewardship programmes (ASPs) are well situated to promote adherence to quality performance measures in order to optimize the management of SAB and associated clinical outcomes.


METHODS
This uncontrolled pre-post quasi-experimental study evaluated compliance with an ASP-driven comprehensive care bundle and associated clinical outcomes for patients with SAB. The ASP provided recommendations to prescribers to promote adherence with quality performance measures, which included: initiate effective antibiotics within 24 h of Gram's stain; achieve therapeutic vancomycin trough concentration; provide β-lactam therapy if MSSA; obtain repeat blood cultures every 48 h until clearance; complete appropriate treatment duration; eliminate or debride foci of infection; and obtain an echocardiogram for complicated bacteraemia.


RESULTS
One hundred and seventy patients with SAB were included: 82 patients in the pre-intervention group and 88 patients in the ASP-intervention group. Overall bundle adherence to quality performance measures improved from 56.1% (46/82) in the pre-intervention group to 84.1% (74/88) in the ASP-intervention group (P < 0.001), which was associated with a reduction in 30 day readmission with SAB [9 patients (11.0%) versus 1 patient (1.1%), P = 0.008]. The 30 day mortality was numerically lower in the ASP-intervention group, but the difference was not statistically significant [16 patients (19.5%) versus 10 patients (11.4%), P = 0.2].


CONCLUSIONS
Implementation of an ASP-driven comprehensive care bundle for SAB improved adherence with performance measures and was associated with a decrease in hospital readmission for SAB.
Department of Pharmacy, University of Michigan Hospitals and Health Systems (UMHS), 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
Cynthia T
CT
Nguyen
Department of Infectious Diseases, University of Michigan Hospitals and Health Systems (UMHS), 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
Tejal
T
Gandhi
Department of Infectious Diseases, University of Michigan Hospitals and Health Systems (UMHS), 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
Carol
C
Chenoweth
Department of Pharmacy, University of Michigan Hospitals and Health Systems (UMHS), 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
Jessica
J
Lassiter
College of Pharmacy, University of Michigan, 428 Church St., Ann Arbor, MI 48109, USA.
Jenny
J
Dela Pena
Department of Pharmacy, University of Michigan Hospitals and Health Systems (UMHS), 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA College of Pharmacy, University of Michigan, 428 Church St., Ann Arbor, MI 48109, USA.
Gregory
G
Eschenauer
Department of Pharmacy, University of Michigan Hospitals and Health Systems (UMHS), 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA nageljl@med.umich.edu.
Jerod L
JL
Nagel
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy*; D003428:Cross Infection / Q000188:drug therapy*; D004363:Drug Utilization / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D065228:Non-Randomized Controlled Trials as Topic; D010359:Patient Readmission; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents