Complete adherence to evidence-based quality-of-care indicators for Staphylococcus aureus bacteremia resulted in better prognosis.

Abstract

Staphylococcus aureus bacteremia (SAB) is a serious clinical condition associated with high morbidity and mortality. Recent studies have revealed that adherence to evidence-based quality-of-care indicators (QCIs) for the management of SAB could result in reduced mortality. We aimed to determine whether compliance with QCIs was associated with mortality and whether compliance with QCIs predicted the mortality of patients with SAB. In a university hospital in Kyoto, Japan, SAB patients, who survived at least 14days after positive blood cultures were analyzed from 2006 to 2014 to assess their compliance with QCIs and the trend in mortality. In addition, the predicted mortality, which was stratified by the number of fulfilled QCIs (QCI points), was calculated. In this study, the following five main QCI points were evaluated: (1) follow-up blood cultures; (2) early source control when applicable; (3) echocardiography; (4) the early use of appropriate antibiotics, and (5) the appropriate duration of therapy. We identified 477 eligible SAB cases, of which 199 were MRSA cases (41.7%). The proportion of SAB cases in which the physicians adhered to at least four QCIs increased gradually from 47.5% in 2006 to 79.3% in 2014 (P=0.001); whereas, the 30-day mortality decreased from 10.0 to 3.4% after treatment completion. With an increase in the proportion of SAB cases adhering to QCIs, better prognoses were observed for patients with SAB. The QCI points reflected the 30-day mortality.