期刊
JOURNAL OF INFECTION
卷 83, 期 6, 页码 656-663出版社
W B SAUNDERS CO LTD
DOI: 10.1016/j.jinf.2021.10.001
关键词
S; aureus; Bacteraemia; Quality indicators; Mortality; Clinical management
资金
- Plan Nacional de I+ D+ I 2013-2016
- Instituto de Salud Carlos III
- Subdireccion General de Redes y Centros de Investigacion Cooperativa
- Ministerio de Economia, Industria y Competitividad
- Spanish Network for Research in Infectious Diseases [REIPI RD16/0016/0003]
- European Development Regional Fund 'A way to achieve Europe'
- Operative program Intelligent Growth 2014-2020
Despite good adherence to previously published QIs for the management of Staphylococcus aureus bacteremia, the 30-day mortality remains high. Risk factors such as persistent bacteremia, infective endocarditis, and SAB of unknown source were associated with increased 30-day mortality. Future research should focus on additional factors to further improve outcomes for patients with SAB.
Objectives: To evaluate the association between compliance with previously published quality indicators (QIs) for the management of Staphylococcus aureus bacteraemia (SAB) and 30-day mortality. Methods: We conducted a post hoc analysis of all adult patients with SAB who were hospitalized at a Spanish university hospital between 2013 and 2018. We evaluated the compliance with 7 QIs of SAB man-agement (i.e., Infectious Diseases consultation, follow-up blood cultures, early source control, echocardio-graphy, early cloxacillin or cefazolin, vancomycin monitoring, and appropriate treatment duration). The QIs compliance rate was considered good if >75% of the QIs recommended in each patient were per -formed. We studied the impact of different risk factors (including QIs compliance) on 30-day all-cause mortality adjusting by multivariable modeling and propensity-matched analysis. Results: We included 441 patients with SAB. The QIs compliance rate was >75% in 361 patients (81.9%). A total of 95 patients (21.5%) died within 30 days after the index blood culture. In the multivariable model, the variables associated with 30-day mortality were: age (OR, 1.1; 95% CI, 1.0-1.1), Charlson comorbidity index (OR, 1.2; 95% CI, 1.1-1.4), persistent bacteraemia > 72 h (OR, 6.0; 95% CI, 3.2-11.5), infective endo-carditis (OR, 2.8; 95% CI, 1.2-6.7), and SAB of unknown source (OR, 3.3; 95% CI, 1.5-7.1). We did not find an association between a global QIs compliance rate of >75% or any individual QI with 30-day mortality. Conclusions: SAB 30-day mortality remains high despite good adherence to previously published QIs for the management of SAB. Future research should focus on additional factors to further improve SAB-related mortality. (c) 2021 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
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