Staphylococcus aureus bacteremia: impact of an intervention program in improving the clinical management and review of the clinical and molecular epidemiology.
Study Type
OBSERVATIONAL
Enrollment
600
Hospital de Puerto Real
Puerto Real, Cádiz, Spain
Hospital Costa del Sol
Marbella, Málaga, Spain
Hospital de Torrecárdenas
Almería, Spain
The overall target is to assess if the implementation of an active intervention program improves clinical management of the disease, according to existing recommendations.
Identify evidence-based quality-of-care indicators (QCIs) for the management of Staphylococcus aureus bacteremia (SAB). See secondary objective for the definitions of QCIs
Time frame: 6 months
Follow-up blood cultures performance of control blood culture 48-96h.
Description:Performance of control blood cultures 48-96 h after antimicrobial therapy was started regardless of clinical evolution Formula:Patients with follow-up blood culture collected×100/Patients alive at 96h.
Time frame: 6 months
Early source control
Description: Removal of nonpermanent vascular catheter whenever the catheter was suspected or confirmed as the source of SAB, or drainage of an abscess in \<72 h. Formula: Patients in which the amenable source was removed in\<72h×100/Patients with source amenable of removal/drainage
Time frame: 6 months
Echocardiography in patients with clinical indications
Description: Performance of echocardiography in patients with complicated bacteremia or predisposing conditions for endocarditis. Formula: Patients with echocardiography×100/Patients with complicated bacteremia or predisposing condition for endocarditis,alive at 96h
Time frame: 6 months
Early use of IV cloxacillin for meticillin susceptible Staphylococcus aureus as definitive therapy
Description: Definitive therapy with intravenous cloxacillin (at least 2 g every 6 h or adjusted based on renal function in renal failure) in cases of methicillin-susceptible strains (allergic patients excluded). Treatment should be started within the first 24 h after methicillin sensitivity was available. For hemodialysis patients, cefazolin 2 g after each hemodialysis session was acceptable Formula: Definitive therapy with IV cloxacillin×100/nonallergic Patients with methicillin-susceptible isolates.
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Hospital de barcelona - SCIAS
Barcelona, Spain
Hospital de Cruces
Bilbao, Spain
Hospital Puerta del Mar
Cadiz, Spain
Hospital Reina Sofía
Córdoba, Spain
Hospital Virgen de las Nieves
Granada, Spain
Hospital Juan Ramón Jiménez
Huelva, Spain
Hospital de San Pedro
Logroño, Spain
...and 6 more locations
Time frame: 6 months
Adjustment of vancomycin dose according to trough levels.
Description: Measurement of trough levels of vancomycin in patients treated for at least 3 d with this antibiotic and adjustment of dose in order to achieve plasma trough levels between 15 and 20 mg/L in survivors Formula: Patients with trough level of vancomycin determined and dose adjusted×100/Patients treated with vancomycin,at 3d.
Time frame: 6 months
Treatment duration according to the complexity of infection.
Description: Duration of antimicrobial therapy of at least 14 d for uncomplicated bacteremia and 28 d for complicated bacteremia. Sequential oral treatment with fluoroquinolone plus rifampin, trimethoprim-sulfamethoxazole, or linezolid was considered accepted in selected case. Formula:Patients with appropriate duration of therapy×100/P alive at 14 or 28d in uncomplicated or complicated bacteremia
Time frame: 6 Months