Performance of processes of care and outcomes in patients with Staphylococcus aureus bacteremia

BACKGROUND: Staphylococcus aureus bacteremia (SAB) is associated with significant morbidity and mortality in hospitalized adults. OBJECTIVE: We aimed to identify current practice patterns in the management of SAB, and to evaluate their association with clinical outcomes. DESIGN: Retrospective cohort study. SETTING: A 1558-bed tertiary care teaching hospital. PATIENTS: Adult patients hospitalized between January 1, 2012 through April 30, 2013, who had at least 1 positive blood culture with S aureus. INTERVENTION: None MEASUREMENTS: Electronic medical records were reviewed and the processes of care in the management of SAB were identified. The main outcome was clinical failure, defined as a composite endpoint of in-hospital mortality and persistent bacteremia. RESULTS: Two hundred fifty episodes of SAB occurred in 241 patients, and 78 (32.4%) had clinical failure. Processes of care that impacted the risk of clinical failure included: timing of follow-up blood cultures (delays of >4 days had a relative risk [RR] of 6.6; 95% confidence interval [CI]: 2.1-20.5; P=0.001), consultation with infectious diseases specialist within 6 days from diagnosis of SAB (RR: 0.3; 95% CI: 0.1-0.9; P=0.03), and use of β-lactams in patients with methicillin-susceptible S aureus bacteremia (RR: 0.1; 95% CI: 0.04-0.5; P=0.002). CONCLUSIONS: The processes of care identified in our study could serve as quality and patient safety indicators for the management of SAB.