Adherence to Quality of Care Indicators in the Management of Staphylococcus aureus Bacteremia

Abstract Background Studies have shown that adherence bacteremia (SAB) is associated with better outcomes and is improved with an Infectious diseases consultation (IDC). Temple University Hospital (TUH) did not mandate an IDC for the management of SAB and the adherence to QCIs and its impact on patient outcomes were unknown. The primary objective of this study was to determine the adherence to QCIs and its impact on outcomes. The secondary objective was to evaluate the impact of IDC on the adherence to QCIs and outcomes. Methods This was a retrospective chart review that examined patients with one documented blood culture growing from July 2015 – June 2016 at TUH. Primary endpoints included the percent adherence to QCIs and difference in outcomes including mortality, length of stay (LOS), and recurrence in regards to QCI adherence. Secondary endpoints included difference in adherence to QCIs and clinical outcomes between patients that had an IDC vs. no IDC. Categorical data and continuous data was analyzed using Fisher’s exact tests or Chi-square and Student’s t-test or Mann Whitney U tests, respectively. Results Of the 119 patients with SAB, empiric therapy was administered within 72 hours to 115 (97%), 109 (92%) had follow-up blood cultures obtained, 101 (85%) received appropriate definitive therapy, 100 (84%) received definitive treatment with 4 days, and 85 (71%) received an ECHO. For the 115 patients who finished or were planned to finish their course of antibiotics, 75 (67%) received therapy for the appropriate duration. There was no significant difference in recurrence and mortality outcomes regardless of the QCIs met, however, there was a significant longer median LOS in patients that received empiric therapy within 72 hours (P = 0.04), appropriate definitive therapy (P = 0.01), and an ECHO (P = 0.00008). IDC was associated with better adherence to the QCIs, however, IDC did not have an impact on recurrence or mortality outcomes. Patients that received an IDC had a significantly longer median LOS compared with patients that did not receive an IDC (P = 0.001). Conclusion IDC was associated with better adherence to the QCIs for the management of SAB, however, adherence to the QCIs and IDC did not impact mortality and recurrence outcomes. Disclosures All authors: No reported disclosures.