title: Performance of processes of care and outcomes in patients with Staphylococcus aureus bacteremia.
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.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A 1558-bed tertiary care teaching hospital.
  
  
  METHODS
  Adult patients hospitalized between January 1, 2012 through April 30, 2013, who had at least 1 positive blood culture with S aureus.
  
  
  METHODS
  None
  
  
  METHODS
  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.
authors.affiliation: Department of Medicine, Jackson Memorial Hospital, Miami, Florida.|Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Rossana
authors.initials: R
authors.lastname: Rosa
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wawrzyniak
authors.affiliation: Department of Medicine, Jackson Memorial Hospital, Miami, Florida.
authors.forename: Maroun
authors.initials: M
authors.lastname: Sfeir
authors.affiliation: Department of Pharmacy, Jackson Memorial Hospital, Miami, Florida.
authors.forename: Laura
authors.initials: L
authors.lastname: Smith
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Lilian M
authors.initials: LM
authors.lastname: Abbo
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000401:mortality; D003428:Cross Infection / Q000401:mortality; D004452:Echocardiography; D005260:Female; D005431:Florida; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D014640:Vancomycin / Q000627:therapeutic use; D047090:beta-Lactams / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D014640:Vancomycin