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Evidence-based care reduces mortality from S. aureus bacteremia

Michihiko Goto

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, from the Center for Comprehensive Access and Delivery Research and Evaluation at the Veterans Affairs Health Care System, 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 evidence-based care processes in routine care for S. aureus bacteremia, including appropriate antibiotic therapy, echocardiography and infectious disease consultation, affects 30-day all-cause mortality. 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. Among patients, 52.4% had infection due to methicillin-resistant S. aureus 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%). 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%). Receipt of 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) was linked to decreased mortality when 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). Increased use of the evidence-based care processes could attribute to approximately 57% (95% CI, 48.4%-69.9%) of the decline in mortality during the study period, according to the researchers.

“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

Disclosure: The researchers report no relevant financial disclosures.