Staphylococcus Aureus Bacteremia
Conditions
Keywords
multiresistant bacteremia, bacteremia management, blood culture
Brief summary
Staphylococcus aureus bacteremia: impact of an intervention program in improving the clinical management and review of the clinical and molecular epidemiology.
Interventions
BEHAVIORALFollow recommendations based on scientific evidence to S. aureus bacteremia management
BEHAVIORALNot to follow recommendations based on scientific evidence to S. aureus bacteremia management
Sponsors
Fundación Pública Andaluza Progreso y Salud
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
14 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients over 14 * Clinical significant bacteremia by S. aureus * Patient hospitalized
Exclusion criteria
* Non clinical significant bacteremia * Ambulatory patient * End-of-life patients
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The overall target is to assess if the implementation of an active intervention program improves clinical management of the disease, according to existing recommendations. | 6 months | Identify evidence-based quality-of-care indicators (QCIs) for the management of Staphylococcus aureus bacteremia (SAB). See secondary objective for the definitions of QCIs |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Early source control | 6 months | Description: Removal of nonpermanent vascular catheter whenever the catheter was suspected or confirmed as the source of SAB, or drainage of an abscess in \<72 h. Formula: Patients in which the amenable source was removed in\<72h×100/Patients with source amenable of removal/drainage |
| Echocardiography in patients with clinical indications | 6 months | Description: Performance of echocardiography in patients with complicated bacteremia or predisposing conditions for endocarditis. Formula: Patients with echocardiography×100/Patients with complicated bacteremia or predisposing condition for endocarditis,alive at 96h |
| Follow-up blood cultures performance of control blood culture 48-96h. | 6 months | Description:Performance of control blood cultures 48-96 h after antimicrobial therapy was started regardless of clinical evolution Formula:Patients with follow-up blood culture collected×100/Patients alive at 96h. |
| Adjustment of vancomycin dose according to trough levels. | 6 months | Description: Measurement of trough levels of vancomycin in patients treated for at least 3 d with this antibiotic and adjustment of dose in order to achieve plasma trough levels between 15 and 20 mg/L in survivors Formula: Patients with trough level of vancomycin determined and dose adjusted×100/Patients treated with vancomycin,at 3d. |
| Treatment duration according to the complexity of infection. | 6 Months | Description: Duration of antimicrobial therapy of at least 14 d for uncomplicated bacteremia and 28 d for complicated bacteremia. Sequential oral treatment with fluoroquinolone plus rifampin, trimethoprim-sulfamethoxazole, or linezolid was considered accepted in selected case. Formula:Patients with appropriate duration of therapy×100/P alive at 14 or 28d in uncomplicated or complicated bacteremia |
| Early use of IV cloxacillin for meticillin susceptible Staphylococcus aureus as definitive therapy | 6 months | Description: Definitive therapy with intravenous cloxacillin (at least 2 g every 6 h or adjusted based on renal function in renal failure) in cases of methicillin-susceptible strains (allergic patients excluded). Treatment should be started within the first 24 h after methicillin sensitivity was available. For hemodialysis patients, cefazolin 2 g after each hemodialysis session was acceptable Formula: Definitive therapy with IV cloxacillin×100/nonallergic Patients with methicillin-susceptible isolates. |
Countries
Spain
Outcome results
None listed