Staphylococcus aureus Bacteremia (SAB) Management in a Large Metropolitan Integrated Health Region: Quality of Care Determinants (QoCD)

John Lam, Stephen Robinson, Daniel Gregson, Ranjani Somayaji, Lisa Welikovitch, John Conly, Michael Parkins
2017 Open Forum Infectious Diseases  
Poster Abstracts • OFID 2017:4 (Suppl 1) • S557 completing serial blood cultures, echocardiography, removal of central venous catheters, source control, use of a β-lactam antibiotic for methicillin-sensitive SAB (MSSA), and appropriate duration of antibiotics (2 weeks for uncomplicated SAB and >4 weeks for complicated SAB). The primary outcome was 30-day mortality. Secondary outcomes included 90-day mortality, persistent SAB, relapsed SAB, length of hospital stay, and 30-day readmission.
more » ... readmission. Results. National guidelines were followed in entirety in 71/150 cases (47% , Table 1 ). Adherence to individual guideline components was variable: serial blood cultures 144/150 (96%), echocardiography 134/150 (89%), removal of central venous catheters 26/34 (75%), source control 57/80 (71%), β-lactam use for MSSA 77/86 (89%), and appropriate antibiotic duration 102/150 (68%). In our multivariate model, adherence to guidelines was not an independent predictor of 30-day mortality or of secondary outcomes with the exception of longer hospital length of stay (LOS). Kaplan-Meier survival curves did not differ based on guideline adherence (Figure 1) . Conclusion. Adherence to national guidelines for SAB management was seen in 47% of cases and was not associated with improved clinical outcomes in our retrospective study. This needs to be reassessed in a prospective study to determine relevance in the current era of increasing healthcare costs and requirements to meet specific performance measures.
doi:10.1093/ofid/ofx163.1452 fatcat:y6ewt2m3ozgtncx6cuozogfruy