Implementing a hospital-wide protocol for Staphylococcus aureus bacteraemia


K. Bolhuis, P.J. De Vries

Woensdag 20 april 2016

15:00 - 15:10u in Zaal 2.1

Categorie├źn: Parallelsessie

Parallel sessie: Parallelsessie 5: Case reports/research


Background: 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.

The medical records of all SAB patients admitted in 2011 and 2012 ('pre') were analysed. In 2013 a protocol, describing the risk factors, diagnostic classification and recommended treatment was implemented. In 2014 ('post') all SAB patients were followed prospectively. Transthoracic or trans-oesophageal cardiac ultrasound was chosen following a decision tree. A resident internal medicine acted as contact person.

Results: Pre-intervention 108 patients were eligible for analysis compared to 44 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 (90% and 80% pre- and post-intervention respectively). Follow-up blood cultures drawn within two days after initiating treatment increased from 49% to 84%. Cardiac ultrasounds increased from 42% to 80% for TTE and 12 % to 23 % for TEE. Endocarditis was more frequently diagnosed (5% vs 17%). Additionally, the duration of antibiotic therapy increased. The 3-month mortality did not change significantly (33% pre-intervention vs. 44% post-intervention; p>0.05).

Conclusion: Introduction of a hospital-wide protocol for SAB management created awareness among clinicians to properly classify SAB, search for endocarditis and adapt duration of antibiotic treatment. Mortality did not decrease.