Skip to main content

Deaths Dropped From S. aureus Bacteremia Linked to Evidence-Based Diagnosis and Care!

Use of three evidence-based practices appears to substantially increase survival of veterans with Staphylococcus aureus bacteremia (SAB), new research suggests.

In a retrospective observational study of nearly 37,000 patients with SAB, 30-day all-cause mortality dropped significantly in concert with study hospitals’ increasing use of appropriate antibiotic therapy, echocardiography, and consultation with infectious disease specialists.
“We believe this makes a strong case for building care-quality metrics to promote use of these evidence-based care processes and improve the care of this serious infection,” first author Dr. Michihiko Goto, of the Iowa City Veterans Health Care System and the University of Iowa, in Iowa City, told Reuters Health by email.
The findings were reported in JAMA Internal Medicine, online September 5.
SAB is common and often associated with poor outcomes, with earlier reports citing mortality rates ranging from 20% to 30%, the researchers noted.
“Previous smaller studies showed several care processes were associated with better outcomes, but it has never been investigated whether they can improve population-based outcomes, (and) it was not clear whether those processes have synergistic or additive benefits,” Dr. Goto said.
In the new study, he noted, the Veterans Health Administration (VHA) “gave us a unique opportunity by providing nationwide microbiology test data, which allowed us to create a large cohort and look into this important question.”
Dr. Goto and colleagues analyzed data from patients with a first episode of SAB who were treated at 124 VHA acute-care hospitals in 2003 through 2014. Of the 36,868 patients (98% male; mean age, 66.4), 52.4% were infected with methicillin-resistant S. aureus (MRSA) and 47.6% had methicillin-susceptible S. aureus (MSSA).
SAB cases in this cohort dropped from 3,717 in 2003 to 2,524 in 2014, largely due to decreases in health care-associated and hospital-onset bacteremia.
After adjustment for age, body-mass index, methicillin susceptibility of the S. aureus isolate, various comorbidities, and other factors, 30-day all-cause mortality decreased significantly from 23.5% in 2003 to 18.2% in 2014. Mortality trends for MRSA and MSSA were similar.
In 2003, 37.4% of SAB patients had care that included a consultation with an infectious disease expert, increasing significantly to 68.0% of SAB patients in 2014. The proportion of patients who received appropriate antibiotic therapy was 66.4% in 2003 versus 78.9% in 2014, and rates of echocardiography increased from 33.8% to 72.8% during the same period (P < 0.001 for both trends).
The percentage of patients who received all three care processes increased significantly from 16.1% in 2003 to 52.2% in 2014.
“Moreover, there was evidence of a dose-response relationship between the number of care processes a patient received and mortality,” the researchers write. Based on the study’s findings, they estimate that 57.3% of the decrease in risk-adjusted mortality could be attributed to increased use of care processes.
“Perhaps the most surprising finding was that it was clear that the more evidence-based care processes a patient receives, the lower the likelihood of death,” Dr. Goto said. Although he and his colleagues expected this dose-response relationship to some degree, “it was even more impressive than we intuitively expected,” he said.
Given that nearly half (47.8%) of patients did not receive all three processes in 2014, stepping up use of these strategies might further improve SAB outcomes, the researchers said.
“The management of Staphylococcus aureus bacteremia, for all its frequency and severity, remains remarkably unencumbered by data,” Dr. Vance Fowler, an infectious disease specialist at Duke University Medical Center, in Durham, North Carolina, told Reuters Health by email. The new study “makes an important step” toward addressing this deficit, he said.
“What I found particularly reassuring was that while each of the three strategies was independently associated with improved outcome, there was also an additive effect so that the more of the three treatment strategies were employed, the better the patient outcome,” said Dr. Fowler, who conducts research on determinants of outcome in patients with SAB but was not involved in the current study.
He noted that the study’s results “are profoundly gratifying personally,” because his own research in the past two decades has demonstrated the importance of echocardiography, consultation with an infectious disease specialist, and antistaphylococcal beta-lactam antibiotics when susceptibilities allow as interventions for SAB.
The study’s findings “inform the medical community that these strategies should be regarded as standard of care wherever they are available,” Dr. Fowler said.
—Joan Stephenson of Source Here

Comments

Popular posts from this blog

PLASMODIASIS: WHAT YOU SHOULD KNOW?

TABLE OF CONTENTS Introduction Life circle of plasmodium Plasmodium in Erythrocytes  Female mosquitoes Species of plasmodium Symptoms of malaria Diagnosis and treatment. Prevention and control. Anti mosquitoes measure Vaccines and Research Plasmodiasis is a term that could be referred to a disorder of parasitic protozoan that is responsible for the breaking down of red blood cell  that gives rise to an infectious blood in the living system. This parasitic protozoan is called the plasmodium. The plasmodium thus released the sporozoites  and the merozoites into the blood stream and then transported to the liver and thus reduces the potency of the immune system. Life circle of plasmodium Malaria is a disease caused by a one-celled parasite known as Plasmodium. The parasite is transmitted to humans by the bite of the female Anopheles mosquito . The Plasmodium parasite spends its life cycle partly in humans and partly in mosquitoes. (A) Mosquito infected with the malaria par

Types Of Cancer

A n abnormal growth of the cell is defines what cancer is about, and this abnormal cell growth are most likely to attack other body part. There are more than hundred types of cancers that can affect man. One of the major cause of cancer is the use of tobacco, others are obesity, lack of nutritional diet, indiscriminate alcohol consumption. Another important cause of cancer is the onset of some diseases. Diseases like Hepatitis B, C and others can distort the genes of cells. One of the most effective way of preventing cancer is by shunning smoking, exercising, controlled alcohol consumption, eating more nutritional diet, early detection of cancerous. Below are the full compilation of the most common type of cancer: Acute Lymphoblastic Leukemia, Adult Acute Lymphoblastic Leukemia, Childhood Acute Myeloid Leukemia, Adult Acute Myeloid Leukemia, Childhood Adrenocortical Carcinoma Adrenocortical Carcinoma, Childhood AIDS-Related Cancers AIDS-Related Lymphoma A

Join MedicalNigeria.com on Telegram!

Incase, you are not aware, aside having a WhatsApp group, we do also have a Telegram group page. Today we invite you to join our MedicalNigeria.com on telegram for job updates and more... Click  HERE  to automatically join our group on Telegram. Remember that if you do not have telegram installed in your phone, you will need to do that first. Don't worry it doesn't take time. You will be joining us in 2 minutes time.  Remember our telegram group link once again is-->    https://t.me/joinchat/ KXUTzk6z6dMEcB5BKV9f-w See you inside!  Once you are in, just type 'Hello!' so we can welcome you.