Date Published: October 25, 2017
Publisher: John Wiley and Sons Inc.
Author(s): Kyohei Miyamoto, Seiya Kato, Junichi Kitayama, Junpei Okawa, Ayana Okamoto, Jun Kamei, Kazuhisa Yoshiya, Hideki Asai, Shingo Adachi, Hidekazu Yukioka, Hiroshi Akimoto, Kazuo Okuchi.
Staphylococcus aureus bacteremia causes significant morbidity and mortality and requires specific management to prevent complications. Most studies evaluating quality of care have been carried out in Europe and North America, and accurate epidemiological data are lacking in Asia. We aimed to describe the epidemiology and evaluate the quality of care for S. aureus bacteremia in Japan.
From February 2011 to January 2014, we undertook a multicenter retrospective observational study in 10 departments of emergency and critical care in Japan. We included 118 hospitalized adult patients with S. aureus bacteremia and evaluated three quality‐of‐care indicators: follow‐up blood culture, treatment duration, and echocardiography.
The mean age of the patients was 63.5 ± 17.0 years. The major source of bacteremia was pneumonia (n = 22, 19%), followed by skin and soft tissue infection (n = 18, 15%). Thirty patients (25%) died in the hospital. Follow‐up blood culture was performed in 21/112 patients (19%). The duration of antimicrobial treatment was sufficient in 49/87 patients (56%). Echocardiography for patients with clinical indication was undertaken in 39/59 patients (66%). Any of the three indicators were inadequate in 101/118 (86%).
The rate of adequate care for S. aureus bacteremia is low in Japan. The low adherence rate for follow‐up blood culture was particularly notable. Staphylococcus aureus bacteremia can be an important target of quality improvement interventions.
STAPHYLOCOCCUS AUREUS is one of the leading causes of bacteremia. Staphylococcus aureus bacteremia (SAB) causes significant morbidity and mortality, and usually causes complications (e.g., infective endocarditis and metastatic abscess). For the prevention and early detection of these complications, US guidelines for methicillin‐resistant S. aureus (MRSA) infection recommended several specific management strategies, particularly follow‐up blood cultures, sufficient treatment duration, and echocardiography.1 Several observational studies have reported that a higher rate of adherence to these recommendations was associated with lower SAB‐related mortality.2, 3
Our study was a multicenter retrospective observational study that was undertaken in 10 departments of emergency and critical care, in 10 different hospitals in Japan. The study design was approved by the institutional review board of Wakayama Medical University (Wakayama, Japan), which waived the requirement for informed consent because of the retrospective and observational nature of the study.
During the 3‐year study period, 118 patients with SAB were identified. The patients’ characteristics are presented in Table 1. The major source of bacteremia was pneumonia (19%), followed by skin and soft tissue infection (15%), and osteoarticular infection (13%). The rate of cases with pneumonia varied greatly across institutions, from 0% to 50%. In particular, two institutes experienced 10 cases of pneumonia (45%), out of 22 cases of pneumonia overall, across all institutes. Non‐survivors were older and had higher APACHE II scores than those of survivors.
In our study, the in‐hospital mortality rate of SAB was 25%. Adherence to the three quality‐of‐care indicators was generally low (19–66%) and, in most patients, adherence to any of the three indicators was considered inadequate.
In‐hospital SAB‐related mortality affected one‐quarter of patients. The rate of adequate care for SAB in Japanese emergency and critical care departments was extremely low. The low adherence rate of follow‐up blood culture was especially notable. Staphylococcus aureus bacteremia should be an important target for quality improvement interventions.
Approval of the research protocol: The protocol for this research project was approved by a suitably constituted Ethics Committee of the institution and it conforms to the provisions of the Declaration of Helsinki (Committee of Wakayama Medical University, Approval No. 1414). It waived the requirement for informed consent because of the retrospective and observational nature of the study.