Mortality in Staphylococcus aureus bacteraemia remains high despite adherence to quality indicators: secondary analysis of a prospective cohort study

• Published in: The Journal of infection 2021-12, Vol.83 (6), p.656-663
• Main Authors: Willekens, Rein, Puig-Asensio, Mireia, Suanzes, Paula, Fernández-Hidalgo, Nuria, Larrosa, Maria N., González-López, Juan J., Rodríguez-Pardo, Dolors, Pigrau, Carles, Almirante, Benito
• Format: Article
• Language: English
• Subjects: Adult; Anti-Bacterial Agents - therapeutic use; Bacteraemia; Bacteremia - drug therapy; Clinical management; Humans; Mortality; Prospective Studies; Quality indicators; Quality Indicators, Health Care; S. aureus; Staphylococcal Infections - drug therapy; Staphylococcus aureus
• ISSN: 0163-4453; 1532-2742
• DOI: 10.1016/j.jinf.2021.10.001

•Staphylococcus aureus bacteraemia-associated mortality remains high.•Adherence to quality indicators in S. aureus bacteraemia might improve mortality.•Unmodifiable factors significantly impact the outcomes of S. aureus bacteraemia.•Mortality is higher in S. aureus bacteraemia of unknown source and endocarditis.•Mortality more than doubled in S. aureus bacteraemia that persisted ≥48 h. To evaluate the association between compliance with previously published quality indicators (QIs) for the management of Staphylococcus aureus bacteraemia (SAB) and 30-day mortality. We conducted a post hoc analysis of all adult patients with SAB who were hospitalized at a Spanish university hospital between 2013 and 2018. We evaluated the compliance with 7 QIs of SAB management (i.e., Infectious Diseases consultation, follow-up blood cultures, early source control, echocardiography, early cloxacillin or cefazolin, vancomycin monitoring, and appropriate treatment duration). The QIs compliance rate was considered good if ≥75% of the QIs recommended in each patient were performed. We studied the impact of different risk factors (including QIs compliance) on 30-day all-cause mortality adjusting by multivariable modeling and propensity-matched analysis. We included 441 patients with SAB. The QIs compliance rate was ≥75% in 361 patients (81.9%). A total of 95 patients (21.5%) died within 30 days after the index blood culture. In the multivariable model, the variables associated with 30-day mortality were: age (OR, 1.1; 95% CI, 1.0–1.1), Charlson comorbidity index (OR, 1.2; 95% CI, 1.1–1.4), persistent bacteraemia >72 h (OR, 6.0; 95% CI, 3.2–11.5), infective endocarditis (OR, 2.8; 95% CI, 1.2–6.7), and SAB of unknown source (OR, 3.3; 95% CI, 1.5–7.1). We did not find an association between a global QIs compliance rate of ≥75% or any individual QI with 30-day mortality. SAB 30-day mortality remains high despite good adherence to previously published QIs for the management of SAB. Future research should focus on additional factors to further improve SAB-related mortality.