A Comparison of Staphylococcus aureus Bacteremia (SAB) Diagnosis and Management: Differences Between Academic and Community Hospital Settings

Abstract

Background. SAB is associated with significant morbidity and mortality. IDSA has evidence-based guidelines that help clinicians in the diagnosis and treatment of SAB. We sought to determine the patient outcomes in an academic setting (AS) for treatment of SAB compared to the community setting (CS). Methods. A retrospective, IRB-approved, electronic chart review at a 223-bed AS with an ID physician-led antimicrobial stewardship program (ASP) was compared to three CS within the health system without ASP from 2012 to 2014. Demographic, antimicrobials, monitoring, guideline adherence, and laboratory/diagnostic variables were collected. Statistical analyses were performed using SPSS software (version 23; IBM Inc.) between the AS and CS. Mean + SD or percentages are reported. Statistical significance was defined as a p value of 0.05. Results. A total of 340 patients were evaluated (39 AS; 301 CS). Males accounted for 53% of patients. There were no differences in APACHE II score between the two groups. MRSA accounted for 39% of the SAB. AS patients were significantly younger compared to CS (AS 56.1 + 17 CS 65.6 + 15.4 years, p 0.001). ID was consulted for management in 78% of all patients. There were no statistically significant differences between the two groups when comparing time to infectious diseases consult, time to appropriate therapy, duration of treatment and hospital length of stay. Compliance with IDSA recommendations including trans-esophageal echocardiogram (TEE), removal of catheter, 28 days of therapy for complex infection, and IV antimicrobials were compared between AS and CS. TEE was performed in 64% of AS compared to 16% in CS (p 0.001). Significantly more AS patients had catheter removed after SAB diagnosis (78% versus 45%, p=0.023). Follow-up blood cultures were obtained significantly more often in the academic setting (95% versus 76%, respectively, p = 0.006). Overall, management of patients in AS was more aligned with IDSA recommendations for SAB compared to CS (92% versus 64%, p 0.001). Conclusion. Patients with SAB managed in an AS followed the IDSA recommendations for diagnosis and management significantly more often compared to the CS. CS may benefit from a dedicated ID physician-led ASP to assist with SAB guidelines adherence.