Hospital-Wide Protocol Significantly Improved Appropriate Management of Patients with <i>Staphylococcus aureus</i> Bloodstream Infection
<b>Background:</b><i>Staphylococcus aureus</i> bloodstream infection (SA-BSI) causes morbidity and mortality. We established a management protocol for patients with SA-BSI aimed at improving quality of care and patient outcomes. <b>Methods:</b> A retrospective pre...
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| Format: | Article |
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MDPI AG
2022-06-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/11/6/827 |
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| author | Kawisara Krasaewes Saowaluck Yasri Phadungkiat Khamnoi Romanee Chaiwarith |
| author_facet | Kawisara Krasaewes Saowaluck Yasri Phadungkiat Khamnoi Romanee Chaiwarith |
| author_sort | Kawisara Krasaewes |
| collection | DOAJ |
| description | <b>Background:</b><i>Staphylococcus aureus</i> bloodstream infection (SA-BSI) causes morbidity and mortality. We established a management protocol for patients with SA-BSI aimed at improving quality of care and patient outcomes. <b>Methods:</b> A retrospective pre–post intervention study was conducted at Maharaj Nakorn Chiang Mai Hospital from 1 October 2019 to 30 September 2020 in the pre-intervention period and from 1 November 2020 to 31 October 2021 in the post-intervention period. <b>Results</b>: Of the 169 patients enrolled, 88 were in the pre-intervention and 81 were in the post-intervention periods. There were similar demographic characteristics between the two periods. In the post-intervention period, evaluations for metastatic infections were performed more frequently, e.g., echocardiography (70.5% vs. 91.4%, <i>p</i> = 0.001). The appropriateness of antibiotic prescription was higher in the post-intervention period (42% vs. 81.5%, <i>p</i> < 0.001). The factors associated with the appropriateness of antibiotic prescription were ID consultation (OR 15.5; 95% CI = 5.9–40.8, <i>p</i> < 0.001), being in the post-intervention period (OR 9.4; 95% CI: 3.5–25.1, <i>p</i> < 0.001), and thorough investigations for metastatic infection foci (OR 7.2; 95% CI 2.1–25.2, <i>p</i> = 0.002). However, the 90-day mortality was not different (34.1% and 27.2% in the pre- and post-intervention periods, respectively). The factors associated with mortality from the multivariate analysis were the presence of alteration of consciousness (OR 11.24; 95% CI: 3.96–31.92, <i>p</i> < 0.001), having a malignancy (OR 6.64; 95% CI: 1.83–24.00, <i>p</i> = 0.004), hypoalbuminemia (OR 5.23; 95% CI: 1.71–16.02, <i>p</i> = 0.004), and having a respiratory tract infection (OR 5.07; 95% CI: 1.53–16.84, <i>p</i> = 0.008). Source control was the only factor that reduced the risk of death (OR 0.08; 95% CI: 0.01–0.53, <i>p</i> = 0.009). <b>Conclusion:</b> One-third of patients died. Hospital-wide protocol implementation significantly improved the quality of care. However, the mortality rate did not decrease. |
| first_indexed | 2024-03-10T00:35:45Z |
| format | Article |
| id | doaj.art-c91b5661cb2440f688c1639b229f5f6b |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-10T00:35:45Z |
| publishDate | 2022-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-c91b5661cb2440f688c1639b229f5f6b2023-11-23T15:18:02ZengMDPI AGAntibiotics2079-63822022-06-0111682710.3390/antibiotics11060827Hospital-Wide Protocol Significantly Improved Appropriate Management of Patients with <i>Staphylococcus aureus</i> Bloodstream InfectionKawisara Krasaewes0Saowaluck Yasri1Phadungkiat Khamnoi2Romanee Chaiwarith3Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Chiang Mai University, Chiang Mai 50200, ThailandDivision of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Chiang Mai University, Chiang Mai 50200, ThailandDiagnostic Laboratory, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, ThailandDivision of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Chiang Mai University, Chiang Mai 50200, Thailand<b>Background:</b><i>Staphylococcus aureus</i> bloodstream infection (SA-BSI) causes morbidity and mortality. We established a management protocol for patients with SA-BSI aimed at improving quality of care and patient outcomes. <b>Methods:</b> A retrospective pre–post intervention study was conducted at Maharaj Nakorn Chiang Mai Hospital from 1 October 2019 to 30 September 2020 in the pre-intervention period and from 1 November 2020 to 31 October 2021 in the post-intervention period. <b>Results</b>: Of the 169 patients enrolled, 88 were in the pre-intervention and 81 were in the post-intervention periods. There were similar demographic characteristics between the two periods. In the post-intervention period, evaluations for metastatic infections were performed more frequently, e.g., echocardiography (70.5% vs. 91.4%, <i>p</i> = 0.001). The appropriateness of antibiotic prescription was higher in the post-intervention period (42% vs. 81.5%, <i>p</i> < 0.001). The factors associated with the appropriateness of antibiotic prescription were ID consultation (OR 15.5; 95% CI = 5.9–40.8, <i>p</i> < 0.001), being in the post-intervention period (OR 9.4; 95% CI: 3.5–25.1, <i>p</i> < 0.001), and thorough investigations for metastatic infection foci (OR 7.2; 95% CI 2.1–25.2, <i>p</i> = 0.002). However, the 90-day mortality was not different (34.1% and 27.2% in the pre- and post-intervention periods, respectively). The factors associated with mortality from the multivariate analysis were the presence of alteration of consciousness (OR 11.24; 95% CI: 3.96–31.92, <i>p</i> < 0.001), having a malignancy (OR 6.64; 95% CI: 1.83–24.00, <i>p</i> = 0.004), hypoalbuminemia (OR 5.23; 95% CI: 1.71–16.02, <i>p</i> = 0.004), and having a respiratory tract infection (OR 5.07; 95% CI: 1.53–16.84, <i>p</i> = 0.008). Source control was the only factor that reduced the risk of death (OR 0.08; 95% CI: 0.01–0.53, <i>p</i> = 0.009). <b>Conclusion:</b> One-third of patients died. Hospital-wide protocol implementation significantly improved the quality of care. However, the mortality rate did not decrease.https://www.mdpi.com/2079-6382/11/6/827<i>S. aureus</i>bloodstream infectionbacteremiaquasi-experimental study |
| spellingShingle | Kawisara Krasaewes Saowaluck Yasri Phadungkiat Khamnoi Romanee Chaiwarith Hospital-Wide Protocol Significantly Improved Appropriate Management of Patients with <i>Staphylococcus aureus</i> Bloodstream Infection Antibiotics <i>S. aureus</i> bloodstream infection bacteremia quasi-experimental study |
| title | Hospital-Wide Protocol Significantly Improved Appropriate Management of Patients with <i>Staphylococcus aureus</i> Bloodstream Infection |
| title_full | Hospital-Wide Protocol Significantly Improved Appropriate Management of Patients with <i>Staphylococcus aureus</i> Bloodstream Infection |
| title_fullStr | Hospital-Wide Protocol Significantly Improved Appropriate Management of Patients with <i>Staphylococcus aureus</i> Bloodstream Infection |
| title_full_unstemmed | Hospital-Wide Protocol Significantly Improved Appropriate Management of Patients with <i>Staphylococcus aureus</i> Bloodstream Infection |
| title_short | Hospital-Wide Protocol Significantly Improved Appropriate Management of Patients with <i>Staphylococcus aureus</i> Bloodstream Infection |
| title_sort | hospital wide protocol significantly improved appropriate management of patients with i staphylococcus aureus i bloodstream infection |
| topic | <i>S. aureus</i> bloodstream infection bacteremia quasi-experimental study |
| url | https://www.mdpi.com/2079-6382/11/6/827 |
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