Performance of processes of care and outcomes in patients with Staphylococcus aureus bacteremia.

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.

DESIGN

Retrospective cohort study.

SETTING

A 1558-bed tertiary care teaching hospital.

PATIENTS: Adult patients hospitalized between January 1, 2012 through April 30, 2013, who had at least 1 positive blood culture with S aureus.

INTERVENTION: None

MEASUREMENTS: 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.