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Evidence-based care reduces mortality among patients with S. aureus bacteremia
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Increasing the use of evidence-based care processes — such as appropriate antibiotic therapy, echocardiography and infectious disease consultation — in routine health care settings may improve survival for patients with Staphylococcus aureus bacteremia, according to findings published in JAMA Internal Medicine.
“Staphylococcus aureus bacteremia is common and frequently associated with poor outcomes,” Michihiko Goto, MD, MSCI, a clinical assistant professor of internal medicine and hospital epidemiologist at the University of Iowa Carver College of Medicine, and colleagues wrote. “Evidence indicates that specific care processes are associated with improved outcomes for patients with S. aureus bacteremia, including appropriate antibiotic prescribing, use of echocardiography to identify endocarditis, and consultation with infectious diseases specialists. Whether use of these care processes has increased in routine care for S. aureus bacteremia or whether use of these processes has led to large-scale improvements in survival is unknown.”
Goto and colleagues conducted a retrospective observational cohort study to assess how these evidence-based care processes affect 30-day all-cause mortality among patients receiving routine care for S. aureus bacteremia. They enrolled 36,868 patients admitted to 124 Veterans Health Administration acute care hospitals for S. aureus bacteremia between Jan. 1, 2003, and Dec. 31, 2014. More than half of patients (52.4%) had infection due to MRSA and 47.6% had infection due to methicillin-susceptible S. aureus.
From 2003 to 2014, there was a decrease in risk-adjusted mortality — from 23.5% (95% CI, 23.3%-23.8%) to 18.2% (95% CI, 17.9%-18.5%) — according to the researchers. In addition, there was an increase in the use of appropriate antibiotic prescribing (from 66.4% to 78.9%), echocardiography (from 33.8% to 72.8%) and consultation with an infectious disease specialist (from 37.4% to 68%). All three care processes — appropriate antibiotics (adjusted OR = 0.74; 95% CI, 0.68-0.79), echocardiography (aOR = 0.73; 95% CI, 0.68-0.78) and infectious disease consultation (aOR = 0.61; 95% CI, 0.56-0.65) — were associated with decreased mortality after adjusting for patient characteristics, cohort year and other care processes.
As patients received more care processes, mortality progressively decreased (aOR = 0.33; 95% CI, 0.30-0.36), the researchers said. Increased use of the evidence-based care processes attributed to an estimated 57.3% (95% CI, 48.4%-69.9%) of the decline in mortality during the study period, they added.
“We observed substantial increases in the use of evidence-based care processes for patients with [S. aureus bacteremia] between 2003 and 2014 that were associated with a marked decrease in mortality,” Goto and colleagues concluded. “There is a need for continued implementation of quality improvement initiatives to increase the adoption of these evidence-based care processes for patients with [S. aureus bacteremia], supported by quality measures that reflect use of these processes.” – by Alaina Tedesco
- Reference:
- Goto M, et al. JAMA Intern Med. 2017;doi:10.1001/jamainternmed.2017.3958.
Disclosures: The authors report no relevant financial disclosures.