Effect of a rapid bacteraemia response programme on Staphylococcus aureus bacteraemia management and mortality

Abstract

Background Staphylococcus aureus bacteraemia confers significant morbidity and mortality. A multi-disciplinary team was created to optimize bacteraemia management. Methods The intervention included integration of rapid diagnostic blood culture processing and a multi-disciplinary approach to real-time management of results. This was a retrospective, pre-post study to compare outcomes in the standard of care (SOC, n = 50) and intervention (n = 100) groups of patients with community-onset S. aureus bacteraemia. Patients were excluded for death before Gram stain result, leaving against medical advice, polymicrobial bacteraemia or withdrawal of life sustaining treatments during hospitalization. The primary outcome was 30-day all-cause mortality. Secondary outcomes were in-hospital, 6 month and 1 year mortality as well as S. aureus-related readmission and time to effective antibiotic therapy. Results 54% of the SOC group and 46% of the intervention group had methicillin-resistant S. aureus infections. The primary outcome, 30-day mortality, was 3% in the intervention group compared to 20% in the SOC group (P = 0.004). There was no difference in in-hospital mortality (P = 0.08) but lower mortality in the intervention group at 30 days (P = 0.003), 6 months (P = 0.005) and 1 year (P < 0.001). S. aureus-related readmission was significantly lower at 31 days-6 months after discharge in the intervention group. Median time to effective antibiotic therapy was 13 h versus 6.3 h in the SOC and intervention groups, respectively. Conclusions The integration of real-time rapid diagnostic blood culture technology tied to immediate clinical actions was associated with improved time to effective therapy and mortality in patients with community-onset S. aureus bacteraemia.