Implementing a hospital-wide protocol for Staphylococcus aureus bacteremia
Staphylococcus aureus bacteraemia (SAB) is associated with high-mortality and complication rates. A multidisciplinary approach is needed to predict, detect and treat complications. In this pre- and post-intervention study, we investigated the effects of a hospital-wide protocol for diagnosis, classi...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6061069/ https://www.ncbi.nlm.nih.gov/pubmed/29855842 http://dx.doi.org/10.1007/s10096-018-3284-9 |
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author | Bolhuis, K. Bakker, L. J. Keijer, J. T. de Vries, P. J. |
author_facet | Bolhuis, K. Bakker, L. J. Keijer, J. T. de Vries, P. J. |
author_sort | Bolhuis, K. |
collection | PubMed |
description | Staphylococcus aureus bacteraemia (SAB) is associated with high-mortality and complication rates. A multidisciplinary approach is needed to predict, detect and treat complications. In this pre- and post-intervention study, we investigated the effects of a hospital-wide protocol for diagnosis, classification and treatment of SAB. It was hypothesized that complications and endocarditis would be better identified and treated. Medical records of SAB patients admitted in 2011 and 2012 (pre) were analysed. In 2013, a protocol, describing risk factors, diagnostic classification and recommended treatment, was implemented. In 2014 and 2015 (post), SAB patients were followed prospectively. Transthoracic (TTE) or transoesophageal cardiac ultrasound (TEE) was chosen following a decision tree. A resident internal medicine acted as contact person. Pre-intervention, 98 patients were eligible for analysis compared to 85 patients post-intervention. Age and number of risk factors were slightly higher post-intervention; other baseline characteristics were similar. Most SAB-patients were classified as complicated (89 and 82% pre- and post-intervention, respectively). Follow-up blood cultures drawn within 2 days after initiating treatment increased from 51 to 85%. Cardiac ultrasounds increased from 44 to 83% for TTE and 13 to 24% for TEE. Endocarditis was more frequently diagnosed (4 vs. 12%). Additionally, duration of antibiotic therapy increased. The 3-month mortality did not change significantly (33% pre-intervention vs. 35% post-intervention; p > 0.05). Introduction of a hospital-wide protocol for SAB management increased standard of care, created awareness among clinicians to properly classify SAB, search for endocarditis and adapt duration of antibiotic treatment. Mortality did not decrease. |
format | Online Article Text |
id | pubmed-6061069 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-60610692018-08-09 Implementing a hospital-wide protocol for Staphylococcus aureus bacteremia Bolhuis, K. Bakker, L. J. Keijer, J. T. de Vries, P. J. Eur J Clin Microbiol Infect Dis Original Article Staphylococcus aureus bacteraemia (SAB) is associated with high-mortality and complication rates. A multidisciplinary approach is needed to predict, detect and treat complications. In this pre- and post-intervention study, we investigated the effects of a hospital-wide protocol for diagnosis, classification and treatment of SAB. It was hypothesized that complications and endocarditis would be better identified and treated. Medical records of SAB patients admitted in 2011 and 2012 (pre) were analysed. In 2013, a protocol, describing risk factors, diagnostic classification and recommended treatment, was implemented. In 2014 and 2015 (post), SAB patients were followed prospectively. Transthoracic (TTE) or transoesophageal cardiac ultrasound (TEE) was chosen following a decision tree. A resident internal medicine acted as contact person. Pre-intervention, 98 patients were eligible for analysis compared to 85 patients post-intervention. Age and number of risk factors were slightly higher post-intervention; other baseline characteristics were similar. Most SAB-patients were classified as complicated (89 and 82% pre- and post-intervention, respectively). Follow-up blood cultures drawn within 2 days after initiating treatment increased from 51 to 85%. Cardiac ultrasounds increased from 44 to 83% for TTE and 13 to 24% for TEE. Endocarditis was more frequently diagnosed (4 vs. 12%). Additionally, duration of antibiotic therapy increased. The 3-month mortality did not change significantly (33% pre-intervention vs. 35% post-intervention; p > 0.05). Introduction of a hospital-wide protocol for SAB management increased standard of care, created awareness among clinicians to properly classify SAB, search for endocarditis and adapt duration of antibiotic treatment. Mortality did not decrease. Springer Berlin Heidelberg 2018-05-31 2018 /pmc/articles/PMC6061069/ /pubmed/29855842 http://dx.doi.org/10.1007/s10096-018-3284-9 Text en © © The Author(s) 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Original Article Bolhuis, K. Bakker, L. J. Keijer, J. T. de Vries, P. J. Implementing a hospital-wide protocol for Staphylococcus aureus bacteremia |
title | Implementing a hospital-wide protocol for Staphylococcus aureus bacteremia |
title_full | Implementing a hospital-wide protocol for Staphylococcus aureus bacteremia |
title_fullStr | Implementing a hospital-wide protocol for Staphylococcus aureus bacteremia |
title_full_unstemmed | Implementing a hospital-wide protocol for Staphylococcus aureus bacteremia |
title_short | Implementing a hospital-wide protocol for Staphylococcus aureus bacteremia |
title_sort | implementing a hospital-wide protocol for staphylococcus aureus bacteremia |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6061069/ https://www.ncbi.nlm.nih.gov/pubmed/29855842 http://dx.doi.org/10.1007/s10096-018-3284-9 |
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