Nagao Miki, Yamamoto Masaki, Matsumura Yasufumi, Yokota Isao, Takakura Shunji, Teramukai Satoshi, Ichiyama Satoshi
Department of Infection Control and Prevention, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Postal code 6068507, Kyoto, Japan.
Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Infection. 2017 Feb;45(1):83-91. doi: 10.1007/s15010-016-0946-3. Epub 2016 Oct 5.
Staphylococcus aureus bacteremia (SAB) is a serious clinical condition associated with high morbidity and mortality. Recent studies have revealed that adherence to evidence-based quality-of-care indicators (QCIs) for the management of SAB could result in reduced mortality. We aimed to determine whether compliance with QCIs was associated with mortality and whether compliance with QCIs predicted the mortality of patients with SAB.
In a university hospital in Kyoto, Japan, SAB patients, who survived at least 14 days after positive blood cultures were analyzed from 2006 to 2014 to assess their compliance with QCIs and the trend in mortality. In addition, the predicted mortality, which was stratified by the number of fulfilled QCIs (QCI points), was calculated. In this study, the following five main QCI points were evaluated: (1) follow-up blood cultures; (2) early source control when applicable; (3) echocardiography; (4) the early use of appropriate antibiotics, and (5) the appropriate duration of therapy.
We identified 477 eligible SAB cases, of which 199 were MRSA cases (41.7 %). The proportion of SAB cases in which the physicians adhered to at least four QCIs increased gradually from 47.5 % in 2006 to 79.3 % in 2014 (P = 0.001); whereas, the 30-day mortality decreased from 10.0 to 3.4 % after treatment completion.
With an increase in the proportion of SAB cases adhering to QCIs, better prognoses were observed for patients with SAB. The QCI points reflected the 30-day mortality.
金黄色葡萄球菌血症（SAB）是一种严重的临床病症，具有较高的发病率和死亡率。近期研究表明，遵循基于证据的SAB管理质量指标（QCI）可降低死亡率。我们旨在确定遵守QCI是否与死亡率相关，以及遵守QCI是否能预测SAB患者的死亡率。
在日本京都的一家大学医院，对2006年至2014年血培养呈阳性后至少存活14天的SAB患者进行分析，以评估他们对QCI的遵守情况和死亡率趋势。此外，计算了根据满足的QCI数量（QCI分数）分层的预测死亡率。在本研究中，评估了以下五个主要的QCI分数：（1）后续血培养；（2）适用时的早期源头控制；（3）超声心动图；（4）早期使用适当的抗生素，以及（5）适当的治疗持续时间。
我们确定了477例符合条件的SAB病例，其中199例为耐甲氧西林金黄色葡萄球菌（MRSA）病例（41.7%）。医生遵守至少四项QCI的SAB病例比例从2006年的47.5%逐渐增加到2014年的79.3%（P = 0.001）；而治疗完成后的30天死亡率从10.0%降至3.4%。
随着遵守QCI的SAB病例比例增加，观察到SAB患者的预后更好。QCI分数反映了30天死亡率。
