title: Quality Improvement of Staphylococcus aureus Bacteremia Management and Predictors of Relapse-free Survival.
abstract: OBJECTIVE
  The purpose of this study is to improve the quality of care and patient outcomes for Staphylococcus aureus bacteremia.
  
  
  METHODS
  A quasi-experimental pre- and postintervention study design was used to compare process and clinical endpoints before and after a quality-improvement initiative. All inpatients >18 years of age with a positive blood culture for S. aureus during the specified pre- and postintervention period with clinical information available in the electronic medical record were included. An institutional protocol for the care of patients with S. aureus bacteremia was developed, formalized, and distributed to providers using a pocket card, an electronic order set, and targeted lectures over a 9-month period.
  
  
  RESULTS
  There were 167 episodes of S. aureus bacteremia (160 patients) identified in the preintervention period, and 127 episodes (123 patients) in the postintervention period. Guideline adherence improved in the postintervention period for usage of transesophageal echocardiogram (43.9% vs 20.2%, P <.01) and adequate duration of intravenous therapy (71% vs 60%, P = .05). In a multivariate Cox proportional hazard model, the variables associated with increased relapse-free survival were postintervention period (hazard ratio [HR] 0.48; confidence interval [CI], 0.24-0.95; P .035) and appropriate source control (HR 0.53; CI, 0.24-0.92; P .027). Regardless of intervention, presence of cancer was associated with an increased risk of relapse or mortality at 90 days (HR 2.88; P <.0001; CI, 1.35-5.01).
  
  
  CONCLUSIONS
  A bundled educational intervention to promote adherence to published guidelines for the treatment of S. aureus bacteremia resulted in a significant improvement in provider adherence to guidelines as well as increased 90-day relapse-free survival.
authors.affiliation: Division of Internal Medicine-Infectious Diseases, University of Texas Southwestern, Dallas. Electronic address: holmseyj@gmail.com.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Townsend
authors.affiliation: Department of Epidemiology, University of Texas Health Science Center School of Public Health, Dallas Campus.
authors.forename: Jamie
authors.initials: J
authors.lastname: Pelletier
authors.affiliation: Division of Internal Medicine-Cardiology, University of Texas Southwestern, Dallas.
authors.forename: Gail
authors.initials: G
authors.lastname: Peterson
authors.affiliation: Division of Internal Medicine-Cardiology, University of Texas Southwestern, Dallas.
authors.forename: Susan
authors.initials: S
authors.lastname: Matulevicius
authors.affiliation: Division of Internal Medicine-Infectious Diseases, University of Texas Southwestern, Dallas; Division of Clinical Quality Management, Parkland Health and Hospital System, Dallas, Texas.
authors.forename: Pranavi
authors.initials: P
authors.lastname: Sreeramoju
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000401:mortality; D002985:Clinical Protocols / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006784:Hospitals, Teaching / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D012008:Recurrence; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000401:mortality; D013781:Texas; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bacteremia/drug therapy; Methicillin resistance; Quality control; Staphylococcal infections/drug therapy; Staphylococcal infections/microbiology