Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Nov 22;37(1):445.
doi: 10.4102/sajid.v37i1.445. eCollection 2022.

Adherence to a care bundle for Staphylococcus aureus bacteraemia: A retrospective cohort study

Elizabeth M Gatley  1 , Tom Boyles  2 , Sipho Dlamini  2 , Marc Mendelson  2 , Phiona E Namale  2 , Peter J Raubenheimer  1 , Sean Wasserman  2
Affiliations

Adherence to a care bundle for Staphylococcus aureus bacteraemia: A retrospective cohort study

Elizabeth M Gatley et al. S Afr J Infect Dis. .

Abstract

Background: Staphylococcus aureus bacteraemia is associated with high hospital mortality. Improvements in outcome have been described with standardised bundles of care.

Objectives: To study the adherence of a standardised bundle of care (BOC) recommendations using a consultation pro forma, for all patients admitted with S. aureus bacteraemia to Groote Schuur Hospital over a year. The study further aimed to describe the 90-day mortality in these patients and to assess for an association between adherence to the bundle of care and outcome.

Method: A retrospective audit of all unsolicited infectious disease consultations for patients with S. aureus bacteraemia admitted to Groote Schuur Hospital during 2018. Adherence to recommendations of a standard bundle of care was audited.

Results: A total of 86 patients were included in the study: 61 (71%) with hospital-associated infection and 25 (29%) with community-associated infection. Over 80% of adherence to treatment recommendations was achieved regarding antibiotic (including vancomycin) usage, source control and use of echocardiography as required. In-hospital mortality was 16%, while the overall 90-day mortality was 18%, with only age as an independent predictor of mortality. No association between adherence to the bundle of care and outcome was found.

Conclusion: Adherence to a simple, structured bundle of care was good when using standardised pro forma as communication tools for advice and a structured antibiotic chart for vancomycin administration. Although adherence was not associated with outcome, the overall mortality for S. aureus bacteraemia was improving in the institution under study.

Contribution: Our findings support feasibility and ongoing use of bundles of care for S. aureus bacteraemia in similar settings.

Keywords: Staphylococcus aureus bacteraemia; adherence; bloodstream infections; bundle of care; infectious disease consultation.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article

Figures

FIGURE 1
FIGURE 1
Survival curves for patients with Staphylococcus aureus bacteraemia. (a) Kaplan–Meier curve for patients with full versus < 100% adherence. (b) The Cox proportional hazards regression stratified by age and adherence. Hazard ratio (HR) (95% confidence interval [CI]) for age > 60 versus not: 7.0 (2.6–20.5); HR (95% CI) for 100% adherent versus not 0.8 (0.3–2.0).
None
None
See this image and copyright information in PMC

References

    1. Biedenbach DJ, Moet GJ, Jones RN. Occurrence and antimicrobial resistance pattern comparisons among bloodstream infection isolates from the SENTRY Antimicrobial Surveillance Program (1997–2002). Diagn Microbiol Infect Dis. 2004;50(1):59–69. 10.1016/j.diagmicrobio.2004.05.003 - DOI - PubMed
    1. Shorr AF, Tabak YP, Killian AD, Gupta V, Liu LZ, Kollef MH. Healthcare-associated bloodstream infection: A distinct entity? Insights from a large U.S. database. Crit Care Med. 2006;34(10):2588–2595. 10.1097/01.CCM.0000239121.09533.09 - DOI - PubMed
    1. Fowler Jr, VG, Olsen MK, Corey GR, et al. . Clinical identifiers of complicated Staphylococcus aureus bacteremia. Arch Intern Med. 2003;163(17):2066–2072. 10.1001/archinte.163.17.2066 - DOI - PubMed
    1. Wyllie DH, Crook DW, Peto TE. Mortality after Staphylococcus aureus bacteraemia in two hospitals in Oxfordshire, 1997–2003: Cohort study. BMJ. 2006;333(7562):281. 10.1136/bmj.38834.421713.2F - DOI - PMC - PubMed
    1. Liu C. Editorial commentary: A quality-of-care bundle for treatment of Staphylococcus aureus bacteremia: Ready for prime time? Clin Infect Dis. 2013;57(9):1234–1236. 10.1093/cid/cit502 - DOI - PubMed

Selected references

    1. Holland TL, Arnold C, Fowler Jr, VG. Clinical management of Staphylococcus aureus bacteremia: A review. JAMA. 2014;312(13):1330–1341. 10.1001/jama.2014.9743 - DOI - PMC - PubMed
    1. Thwaites GE, Edgeworth JD, Gkrania-Klotsas E, et al. . Clinical management of Staphylococcus aureus bacteraemia. Lancet Infect Dis. 2011;11(3):208–222. 10.1016/S1473-3099(10)70285-1 - DOI - PubMed

LinkOut - more resources