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Implementing a hospital-wide protocol for Staphylococcus aureus bacteremia.

K Bolhuis1, L J Bakker2, J T Keijer3

  • 1Department of Internal Medicine, Academic Medical Center, Meijbergdreef 9, 1105 AZ, Amsterdam, The Netherlands. k.bolhuis@amc.nl.

European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology
|June 2, 2018
PubMed
Summary

A new hospital protocol for Staphylococcus aureus bacteraemia (SAB) improved diagnosis and treatment of complications like endocarditis. However, the high mortality rate associated with SAB did not significantly change.

Keywords:
BacteraemiaEchocardiographyInfective endocarditisStaphylococcus aureusTreatment

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Area of Science:

  • Infectious Diseases
  • Internal Medicine
  • Clinical Protocol Implementation

Background:

  • Staphylococcus aureus bacteraemia (SAB) presents significant mortality and complication risks.
  • Effective management requires a multidisciplinary approach for prediction, detection, and treatment of complications.
  • Endocarditis is a severe complication of SAB requiring timely diagnosis and intervention.

Purpose of the Study:

  • To evaluate the impact of a hospital-wide protocol on the diagnosis, classification, and treatment of SAB.
  • To determine if the protocol improved the identification and management of complications, particularly endocarditis.
  • To assess changes in clinical practices and patient outcomes following protocol implementation.

Main Methods:

  • A pre- and post-intervention study design was employed.
  • Patient data from before (2011-2012) and after (2014-2015) protocol implementation were analyzed.
  • Key metrics included follow-up blood cultures, cardiac ultrasound utilization (TTE/TEE), endocarditis diagnosis rates, antibiotic therapy duration, and 3-month mortality.

Main Results:

  • The protocol increased timely follow-up blood cultures (51% to 85%) and cardiac ultrasound use (TTE: 44% to 83%; TEE: 13% to 24%).
  • Endocarditis diagnosis rose significantly (4% to 12%), and antibiotic therapy duration increased.
  • Despite improved care standards, 3-month mortality remained unchanged (33% pre-intervention vs. 35% post-intervention).

Conclusions:

  • Implementation of a hospital-wide SAB protocol enhanced clinical awareness and adherence to standard care guidelines.
  • The protocol successfully improved the classification of SAB and the detection of endocarditis.
  • While diagnostic and treatment practices improved, the protocol did not significantly reduce the high mortality associated with SAB.