Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla.
Clin Infect Dis. 2013 Nov;57(9):1225-33. doi: 10.1093/cid/cit499. Epub 2013 Aug 8.
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.
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.
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).
A bundle orientated to improving adherence to evidence-based QCIs improved the management of patients with SAB and was associated with reduced mortality.
金黄色葡萄球菌菌血症（SAB）与较高的发病率和死亡率相关。临床管理的几个方面已被证明对预后有重大影响。本研究的目的是确定 SAB 管理的基于循证的质量控制指标（QCIs），并评估基于 QCI 的护理包对 SAB 的管理和预后的影响。
对文献进行系统回顾，以确定 SAB 管理中的 QCIs。然后，在 12 家西班牙三级医院进行的准实验研究中评估了包括选定 QCIs 的护理包的影响。主要和次要结局变量是对 QCIs 的依从性和死亡率。针对 SAB 管理的 6 项选定循证 QCIs，提供了具体的结构化个体化书面建议。
干预前和干预期间分别纳入 287 例和 221 例患者。在控制了潜在的混杂因素后，干预与提高随访血培养的依从性（优势比[OR]，2.83；95%置信区间[CI]，1.78-4.49）、早期源头控制（OR，4.56；95%CI，2.12-9.79）、早期静脉注射氯唑西林治疗耐甲氧西林敏感分离株（OR，1.79；95%CI，1.15-2.78）和适当的治疗持续时间（OR，2.13；95%CI，1.24-3.64）独立相关。干预与 14 天和 30 天死亡率降低独立相关（OR，0.47；95%CI，.26-.85 和 OR，0.56；95%CI，.34-.93）。
针对提高对循证 QCIs 的依从性的护理包改善了 SAB 患者的管理，并与死亡率降低相关。
