Krasaewes Kawisara, Yasri Saowaluck, Khamnoi Phadungkiat, Chaiwarith Romanee
Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Diagnostic Laboratory, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Antibiotics (Basel). 2022 Jun 20;11(6):827. doi: 10.3390/antibiotics11060827.
Background:Staphylococcus aureus bloodstream infection (SA-BSI) causes morbidity and mortality. We established a management protocol for patients with SA-BSI aimed at improving quality of care and patient outcomes. Methods: A retrospective pre−post intervention study was conducted at Maharaj Nakorn Chiang Mai Hospital from 1 October 2019 to 30 September 2020 in the pre-intervention period and from 1 November 2020 to 31 October 2021 in the post-intervention period. Results: Of the 169 patients enrolled, 88 were in the pre-intervention and 81 were in the post-intervention periods. There were similar demographic characteristics between the two periods. In the post-intervention period, evaluations for metastatic infections were performed more frequently, e.g., echocardiography (70.5% vs. 91.4%, p = 0.001). The appropriateness of antibiotic prescription was higher in the post-intervention period (42% vs. 81.5%, p < 0.001). The factors associated with the appropriateness of antibiotic prescription were ID consultation (OR 15.5; 95% CI = 5.9−40.8, p < 0.001), being in the post-intervention period (OR 9.4; 95% CI: 3.5−25.1, p < 0.001), and thorough investigations for metastatic infection foci (OR 7.2; 95% CI 2.1−25.2, p = 0.002). However, the 90-day mortality was not different (34.1% and 27.2% in the pre- and post-intervention periods, respectively). The factors associated with mortality from the multivariate analysis were the presence of alteration of consciousness (OR 11.24; 95% CI: 3.96−31.92, p < 0.001), having a malignancy (OR 6.64; 95% CI: 1.83−24.00, p = 0.004), hypoalbuminemia (OR 5.23; 95% CI: 1.71−16.02, p = 0.004), and having a respiratory tract infection (OR 5.07; 95% CI: 1.53−16.84, p = 0.008). Source control was the only factor that reduced the risk of death (OR 0.08; 95% CI: 0.01−0.53, p = 0.009). Conclusion: One-third of patients died. Hospital-wide protocol implementation significantly improved the quality of care. However, the mortality rate did not decrease.
金黄色葡萄球菌血流感染（SA-BSI）可导致发病和死亡。我们为SA-BSI患者制定了一项管理方案，旨在提高护理质量和患者预后。方法：于2019年10月1日至2020年9月30日在清迈玛哈叻吉医院进行干预前回顾性研究，于2020年11月1日至2021年10月31日进行干预后研究。结果：纳入的169例患者中，88例处于干预前期，81例处于干预后期。两个时期的人口统计学特征相似。在干预后期，对转移性感染的评估更为频繁，例如超声心动图检查（70.5%对91.4%，p = 0.001）。干预后期抗生素处方的合理性更高（42%对81.5%，p < 0.001）。与抗生素处方合理性相关的因素包括感染病科会诊（比值比15.5；95%置信区间=5.9−40.8，p < 0.001）、处于干预后期（比值比9.4；95%置信区间：3.5−25.1，p < 0.001）以及对转移性感染灶进行全面检查（比值比7.2；95%置信区间2.1−25.2，p = 0.002）。然而，90天死亡率并无差异（干预前期和后期分别为34.1%和27.2%）。多因素分析中与死亡相关的因素包括意识改变（比值比11.24；95%置信区间：3.96−31.92，p < 0.001）、患有恶性肿瘤（比值比6.64；95%置信区间：1.83−24.00，p = 0.004）、低白蛋白血症（比值比5.23；95%置信区间：1.71−16.02，p =
