Clinical questions: What are the trends in patient outcome for Staphylococcus aureus bacteremia (SAB)? Does the use of evidence-based care processes decrease mortality in SAB?
Background: SAB is associated with poor clinical outcomes. Prior research has demonstrated that several evidence-based interventions, namely appropriate antibiotics, echocardiography, and infectious disease consults, have been associated with improved outcomes. The use of these interventions in clinical practice and their large-scale impact on SAB mortality is not known.
Dr. Jorge Rodriguez
Study design: Retrospective observational cohort study.
Setting: Veterans Health Administration acute care hospitals in the continental United States from January 1, 2003, to Dec. 31, 2014.
Synopsis: This study used the Veterans Affairs Informatics and Computing Infrastructure to identify 36,868 patients across 124 acute care hospitals with a first episode of SAB. Use of evidence-based care processes (specifically appropriate antibiotic use, echocardiography, and infectious disease consults) and patient mortality were recorded.
All-cause 30-day mortality decreased 25.7% in 2003 to 16.5% in 2014. Concurrently, the rate of evidence-based care processes increased from 2003 to 2014. There was lower risk-adjusted mortality when patients received all three evidence-based care processes compared to those who received none, with an odds ratio of 0.33 (95% confidence interval, 0.30-0.37); 57.3% of the decrease in mortality was attributable to use of all three evidence-based care processes.
Given the observational nature of the study, unmeasured confounders were not considered. Generalizability of the study is limited since the patients were primarily men.
Bottom line: The use of evidence-based care processes (appropriate antibiotic use, echocardiography, and infectious disease consultation) was associated with decreased SAB mortality.
Citation: Goto M et al. Association of evidence-based care processes with mortality in Staphylococcus aureus bacteremia at Veterans Health Administration hospitals, 2003-2014. JAMA Intern Med. 2017;177(10):1489-97.
Dr. Rodriguez is a hospitalist and a clinical informatics fellow, Beth Israel Deaconess Medical Center, Boston.