An Audit of Staphylococcus aureus Bacteraemia Treatment in a UK District General Hospital

Year 2017, Volume: 07 Issue: 04, 188 - 193, 01.12.2017

Christine Scarsbrook Nadeem Sajjad Raja Michael Hardman Kath Hughes

https://doi.org/10.5799/jmid.369266

Abstract

Objective: Recent guidelines from Healthcare Improvement Scotland
recommend that uncomplicated Staphylococcus aureus bacteraemia (SAB) be treated
with effective antibiotics for at least 14 days.  This audit aimed to see whether Medway
Hospital, UK, was following these guidelines, and whether a simple intervention
could improve compliance and therefore treatment.

Method:
All patients with SAB between April 2013 and September 2014 were identified and
their clinical notes, laboratory findings and drug charts were reviewed.
Starting in January 2014 all SAB were reported on the online pathology results
system with the following advice; ‘Staphylococcus aureus bacteraemia warrants a
minimum of 14 days treatment. Treatment may be longer in cases of deep seated
infection.’ Outcome measures included 14 days antimicrobial treatment
readmission rate with SAB, 3 month mortality post treatment and whether
echocardiography was performed.

Results:
The demographics of all patients (35 pre and 39 post intervention) were
comparable between groups (average age 63 vs 56, 54.3% vs 69.2% male) although
the sources of bacteraemia differed slightly. More patients had indwelling
lines in 2013 and there were a higher proportion of IV drug users in 2014; all
other risk factors were similar between groups. More patients received
appropriate antibiotics post intervention (74% vs 49%). Three month mortality
with community acquired SAB increased but mortality with hospital acquired SAB decreased
post intervention. Echocardiography uptake improved, and readmission rates with
SAB decreased.

Conclusion: The introduction of guidance with blood culture
results has demonstrated better compliance with a 14 day minimum treatment
length for SAB.  Although sample size
limits obtaining a statistically significant difference in readmission and
mortality rates, this intervention still has the potential to improve treatment
of SAB in aiding clinicians to follow guidelines. J Microbiol Infect Dis 2017; 7(4):188-193

Keywords

HIV, HCV, Genotype, Co-infection, Viral load

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