Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-28T04:20:57.577Z Has data issue: false hasContentIssue false
  • English
  • Français

Description of a pharmacist-driven safety algorithm in Staphylococcus aureus bacteremia: Compliance, interventions, and good saves

Published online by Cambridge University Press:  16 June 2020

Tara H. Lines Open the ORCID record for Tara H. Lines [Opens in a new window] ,
Whitney J. Nesbitt Open the ORCID record for Whitney J. Nesbitt [Opens in a new window] ,
Matthew H. Greene Open the ORCID record for Matthew H. Greene [Opens in a new window]  and
George E. Nelson Open the ORCID record for George E. Nelson [Opens in a new window]
Tara H. Lines*
Affiliation:
Department of Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee
Whitney J. Nesbitt
Affiliation:
Department of Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee
Matthew H. Greene
Affiliation:
Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
George E. Nelson
Affiliation:
Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
*
Author for correspondence: Tara H. Lines, E-mail: Linesth@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To evaluate the impact of a pharmacist-driven Staphylococcus aureus bacteremia (SAB) safety bundle supported by leadership and to compare compliance before and after implementation.

Design:

Retrospective cohort study with descriptive and before-and-after analyses.

Setting:

Tertiary-care academic medical center.

Patients:

All patients with documented SAB, regardless of the source of infection, were included. Patients transitioned to palliative care were excluded from before-and-after analysis.

Methods:

A pharmacist-driven safety bundle including documented clearance of bacteremia, echocardiography, removal of central venous catheters, and targeted intravenous therapy of at least 2 weeks duration was implemented in November 2015 and was supported by leadership with stepwise escalation for nonresponse. A descriptive analysis of all patients with SAB during the study period included pharmacy interventions, acceptance rates, and escalation rates. A pre–post implementation analysis of 100 sequential patients compared bundle compliance and descriptive parameters.

Results:

Overall, 391 interventions were made in the 20-month period following implementation, including 20 “good saves” avoiding potentially major adverse events. No statistically significant differences in complete bundle compliance were detected between the periods (74% vs 84%; P = .08). However, we detected a significant increase in echocardiography after the bundle was implemented (83% vs 94%; P = .02) and fewer patients received suboptimal definitive therapy after the bundle was implemented (10% vs 3%; P = .045).

Conclusions:

This pharmacist-driven SAB safety bundle with leadership support showed improvement in process measures, which may have prevented major adverse events, even with available infectious diseases (ID) consultation. It provides a critical safety net for institutions without mandatory ID consultation or with limited antimicrobial stewardship resources.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 8 , August 2020 , pp. 921 - 925
Check for updates
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION. These data were presented in a poster at the Vizient Consortium Pharmacy Network Meeting on December 2, 2017, in Las Vegas, Nevada.

References

Fries, BL, Licitra, C, Crespo, A, et al.Infectious diseases consultation and the management of Staphylococcus aureus bacteremia. Clin Infect Dis 2014;58:598–599.CrossRefGoogle ScholarPubMed
Vogel, M, Schmitz, RPH, Hagel, S, et al.Infectious disease consultation for Staphylococcus aureus bacteremia—a systematic review and meta-analysis. J Infect 2016;72:19–28.CrossRefGoogle Scholar
Tissot, F, Calandra, T, Prod’hom, G, et al.Mandatory infectious diseases consultation for MRSA bacteremia is associated with reduced mortality. J Infect 2014;69:226–234.CrossRefGoogle ScholarPubMed
Rasmussen, RV, Host, U, Arpi, M, et al.Prevalence of infective endocarditis in patients with Staphylococcus aureus bacteraemia: the value of screening with echocardiography. Eur J Echocardiogr 2011;12:414–420.CrossRefGoogle ScholarPubMed
Chang, F-Y, MacDonald, BB, Peacock, JEJ, et al.A prospective multicenter study of Staphylococcus aureus bacteremia: incidence of endocarditis, risk factors for mortality, and clinical impact of methicillin resistance. Medicine (Baltimore) 2003;82:322–332.CrossRefGoogle ScholarPubMed
Salvador, VBD, Chapagain, B, Joshi, A, Brennessel, DJ. Clinical risk factors for infective endocarditis in Staphylococcus aureus bacteremia. Texas Hear Inst J 2017;44:10–15.CrossRefGoogle ScholarPubMed
Liu, C, Bayer, A, Cosgrove, SE, et al.Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis 2011;52:285–292.CrossRefGoogle Scholar
Wenzler, E, Wang, F, Goff, DA, et al.An automated, pharmacist-driven initiative improves quality of care for Staphylococcus aureus bacteremia. Clin Infect Dis 2017;65:194–200.CrossRefGoogle ScholarPubMed
Lopez-Cortes, LE, Del Toro, MD, Galvez-Acebal, J, et al.Impact of an evidence-based bundle intervention in the quality-of-care management and outcome of Staphylococcus aureus bacteremia. Clin Infect Dis 2013;57:1225–1233.CrossRefGoogle ScholarPubMed
Nagao, M, Yamamoto, M, Matsumura, Y, et al.Complete adherence to evidence-based quality-of-care indicators for Staphylococcus aureus bacteremia resulted in better prognosis. Infection 2017;45:83–91.CrossRefGoogle ScholarPubMed
Townsend, J, Pelletier, J, Peterson, G, Matulevicius, S, Sreeramoju, P. Quality improvement of Staphylococcus aureus bacteremia management and predictors of relapse-free survival. Am J Med 2016;129:195–203.CrossRefGoogle ScholarPubMed
Borde, JP, Batin, N, Rieg, S, et al.Adherence to an antibiotic stewardship bundle targeting Staphylococcus aureus bloodstream infections at a 200-bed community hospital. Infection 2014;42:713–719.CrossRefGoogle Scholar
Nguyen, CT, Gandhi, T, Chenoweth, C, et al.Impact of an antimicrobial stewardship-led intervention for Staphylococcus aureus bacteraemia: a quasi-experimental study. J Antimicrob Chemother 2015;70:3390–3396.Google ScholarPubMed
Martin, L, Harris, MT, Brooks, A, Main, C, Mertz, D. Management and outcomes in patients with Staphylococcus aureus bacteremia after implementation of mandatory infectious diseases consult: a before/after study. BMC Infect Dis 2015;15:568.CrossRefGoogle ScholarPubMed
Bai, AD, Showler, A, Burry, L, et al.Impact of infectious disease consultation on quality of care, mortality, and length of stay in Staphylococcus aureus bacteremia: results from a large multicenter cohort study. Clin Infect Dis 2015;60:1451–1461.CrossRefGoogle ScholarPubMed
Buehrle, K, Pisano, J, Han, Z, Pettit, NN. Guideline compliance and clinical outcomes among patients with Staphylococcus aureus bacteremia with infectious diseases consultation in addition to antimicrobial stewardship-directed review. Am J Infect Control 2017;45:713–716.CrossRefGoogle ScholarPubMed
Gancher, E, Maslak, G, Lustgarten, J, Schultz, S, Ingilizova, M. 1220. Impact of mandatory infectious diseases consultation on the use of core measures and mortality in Staphylococcus aureus bacteremia (SAB) at an academic medical center. Open Forum Infect Dis 2018;5 suppl 1:S370–S370.CrossRefGoogle Scholar
Smith, JR, Frens, JJ, Snider, CB, Claeys, KC. Impact of a pharmacist-driven care package on Staphylococcus aureus bacteremia management in a large community healthcare network: a propensity score-matched, quasi-experimental study. Diagn Microbiol Infect Dis 2018;90:50–54.CrossRefGoogle Scholar
Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377–381.CrossRefGoogle ScholarPubMed
Nagao, M, Iinuma, Y, Saito, T, et al.Close cooperation between infectious disease physicians and attending physicians can result in better management and outcome for patients with Staphylococcus aureus bacteraemia. Clin Microbiol Infect 2010;16:1783–1788.CrossRefGoogle ScholarPubMed
Supplementary material: File

Lines et al. supplementary material

Lines et al. supplementary material

Download Lines et al. supplementary material(File)
File 432.3 KB