Impact of adherence to individual quality-of-care indicators on the prognosis of bloodstream infection due to Staphylococcus aureus: a prospective observational multicenter cohort.
Escrihuela-Vidal F., Kaasch AJ., von Cube M., Rieg S., Kern WV., Seifert H., Kyoung-Ho SONG., Chun-Hsing LIAO., Tilley R., Gott H., Scarborough M., Claire Gordon N., Llewelyn MJ., Kuehl R., Morata L., Soriano A., Edgeworth J., Gopegui ERDE., Nsutebu E., Miguel Cisneros J., Fowler VG., Thwaites G., Lopez-Contreras J., Barlow G., Guillermo Ternavasio-DE LA Vega H., Rodríguez-Baño J., López-Cortés LE., International Staphylococcus aureus collaboration (ISAC) study group None., Cueto MD., Morales I., Kim HB., Kim C-J., Kang CK., Park JI., Kim ES., Bernasch C., Stefanik D., Jung N., Hellmich M., Wilson P., Reyes A., Rahman S., Dean V., Morris-Jones S., Marcos M., Török E., Gouliouris T., Bedford L., Pérez JL., Martín-Pena ML., Hopkins S., Soria KL., Mirelis B., Rivera Martinez MA., Prim N., Ferrer MG., Ruffin F., Lepe JA., Roca C., Price JR., Dunne A., Behar L., Martínez JA., Kamfose M., Young B., ESCMID Study Group for Bloodstream Infections, Endocarditis and Sepsis (ESGBIES) None.
OBJECTIVES: To analyze the adherence and impact of quality-of-care indicators (QCI) in the management of Staphylococcus aureus bloodstream infection in a prospective and multicenter cohort. METHODS: Analysis of the prospective, multicenter international ISAC cohort of SAB cases observed between January 2013 and April 2015. Multivariable analysis was performed to evaluate the impact of adherence to QCIs on 90-day mortality. RESULTS: A total of 1,784 cases were included. Overall, 90-day mortality was 29.9%, mean follow-up 118 days. Adherence was 67% (n=1180/1762) for follow-up blood cultures, 31% (n=416/1342) for early focus control, 77.6% (n=546/704) for performance of echocardiography, 75.5% (n=1348/1784) for adequacy of targeted antimicrobial therapy, 88.6% (n=851/960) for adequacy of treatment duration in non-complicated bloodstream infections and 61.2% (n=366/598) in complicated bloodstream infections. Full bundle adherence was 18.4% (n=328/1784). After controlling for immortal time bias and potential confounders, focus control (aHR = .76; 95% CI, .59-.99; P = .038) and adequate targeted antimicrobial therapy (aHR = .75; 95% CI, .61-.91; P = .004) were associated with lower 90-day mortality. CONCLUSIONS: Adherence to QCIs in SAB did not reach expected rates. Apart from the benefits of application as a bundle, focus control and adequate targeted therapy were independently associated with lower mortality.