| Autor: |
López-Cortés, Luis E., del Toro, Maria Dolores, Gálvez-Acebal, Juan, Bereciartua-Bastarrica, Elena, Fariñas, María Carmen, Sanz-Franco, Mercedes, Natera, Clara, Corzo, Juan E., Lomas, José Manuel, Pasquau, Juan, del Arco, Alfonso, Martínez, María Paz, Romero, Alberto, Muniain, Miguel A., de Cueto, Marina, Pascual, Álvaro, Rodríguez-Baño, Jesús |
| Předmět: |
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| Zdroj: |
Clinical Infectious Diseases; Nov2013, Vol. 57 Issue 9, p1225-1233, 9p |
| Abstrakt: |
A clinical intervention on Staphylococcus aureus bacteremia (SAB) based on 6 selected evidence-based quality-of-care indicators was conducted in 12 tertiary hospitals in Spain. The intervention, carried out by microbiologists and infectologists, improved the management and mortality of patients with SAB.Background. Staphylococcus aureus bacteremia (SAB) is associated with significant morbidity and mortality. Several aspects of clinical management have been shown to have significant impact on prognosis. The objective of the study was to identify evidence-based quality-of-care indicators (QCIs) for the management of SAB, and to evaluate the impact of a QCI-based bundle on the management and prognosis of SAB.Methods. A systematic review of the literature to identify QCIs in the management of SAB was performed. Then, the impact of a bundle including selected QCIs was evaluated in a quasi-experimental study in 12 tertiary Spanish hospitals. The main and secondary outcome variables were adherence to QCIs and mortality. Specific structured individualized written recommendations on 6 selected evidence-based QCIs for the management of SAB were provided.Results. A total of 287 and 221 patients were included in the preintervention and intervention periods, respectively. After controlling for potential confounders, the intervention was independently associated with improved adherence to follow-up blood cultures (odds ratio [OR], 2.83; 95% confidence interval [CI], 1.78–4.49), early source control (OR, 4.56; 95% CI, 2.12–9.79), early intravenous cloxacillin for methicillin-susceptible isolates (OR, 1.79; 95% CI, 1.15–2.78), and appropriate duration of therapy (OR, 2.13; 95% CI, 1.24–3.64). The intervention was independently associated with a decrease in 14-day and 30-day mortality (OR, 0.47; 95% CI, .26–.85 and OR, 0.56; 95% CI, .34–.93, respectively).Conclusions. A bundle orientated to improving adherence to evidence-based QCIs improved the management of patients with SAB and was associated with reduced mortality. [ABSTRACT FROM PUBLISHER] |
| Databáze: |
Complementary Index |
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