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Article

Hospital-Wide Protocol Significantly Improved Appropriate Management of Patients with Staphylococcus aureus Bloodstream Infection

1
Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
2
Diagnostic Laboratory, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
*
Author to whom correspondence should be addressed.
Academic Editors: Islam M. Ghazi and Diaa Alrahmany
Antibiotics 2022, 11(6), 827; https://doi.org/10.3390/antibiotics11060827
Received: 16 May 2022 / Revised: 15 June 2022 / Accepted: 17 June 2022 / Published: 20 June 2022
Background:Staphylococcus aureus bloodstream infection (SA-BSI) causes morbidity and mortality. We established a management protocol for patients with SA-BSI aimed at improving quality of care and patient outcomes. Methods: A retrospective pre–post intervention study was conducted at Maharaj Nakorn Chiang Mai Hospital from 1 October 2019 to 30 September 2020 in the pre-intervention period and from 1 November 2020 to 31 October 2021 in the post-intervention period. Results: Of the 169 patients enrolled, 88 were in the pre-intervention and 81 were in the post-intervention periods. There were similar demographic characteristics between the two periods. In the post-intervention period, evaluations for metastatic infections were performed more frequently, e.g., echocardiography (70.5% vs. 91.4%, p = 0.001). The appropriateness of antibiotic prescription was higher in the post-intervention period (42% vs. 81.5%, p < 0.001). The factors associated with the appropriateness of antibiotic prescription were ID consultation (OR 15.5; 95% CI = 5.9–40.8, p < 0.001), being in the post-intervention period (OR 9.4; 95% CI: 3.5–25.1, p < 0.001), and thorough investigations for metastatic infection foci (OR 7.2; 95% CI 2.1–25.2, p = 0.002). However, the 90-day mortality was not different (34.1% and 27.2% in the pre- and post-intervention periods, respectively). The factors associated with mortality from the multivariate analysis were the presence of alteration of consciousness (OR 11.24; 95% CI: 3.96–31.92, p < 0.001), having a malignancy (OR 6.64; 95% CI: 1.83–24.00, p = 0.004), hypoalbuminemia (OR 5.23; 95% CI: 1.71–16.02, p = 0.004), and having a respiratory tract infection (OR 5.07; 95% CI: 1.53–16.84, p = 0.008). Source control was the only factor that reduced the risk of death (OR 0.08; 95% CI: 0.01–0.53, p = 0.009). Conclusion: One-third of patients died. Hospital-wide protocol implementation significantly improved the quality of care. However, the mortality rate did not decrease. View Full-Text
Keywords: S. aureus; bloodstream infection; bacteremia; quasi-experimental study S. aureus; bloodstream infection; bacteremia; quasi-experimental study
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MDPI and ACS Style

Krasaewes, K.; Yasri, S.; Khamnoi, P.; Chaiwarith, R. Hospital-Wide Protocol Significantly Improved Appropriate Management of Patients with Staphylococcus aureus Bloodstream Infection. Antibiotics 2022, 11, 827. https://doi.org/10.3390/antibiotics11060827

AMA Style

Krasaewes K, Yasri S, Khamnoi P, Chaiwarith R. Hospital-Wide Protocol Significantly Improved Appropriate Management of Patients with Staphylococcus aureus Bloodstream Infection. Antibiotics. 2022; 11(6):827. https://doi.org/10.3390/antibiotics11060827

Chicago/Turabian Style

Krasaewes, Kawisara, Saowaluck Yasri, Phadungkiat Khamnoi, and Romanee Chaiwarith. 2022. "Hospital-Wide Protocol Significantly Improved Appropriate Management of Patients with Staphylococcus aureus Bloodstream Infection" Antibiotics 11, no. 6: 827. https://doi.org/10.3390/antibiotics11060827

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