Impact of adherence to quality indicators and effects of targeted treatment with cefazolin or flucloxacillin on in-hospital mortality in patients with methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections: a retrospective observational study.

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2025-01-27 DOI:10.1007/s15010-025-02473-4

Sven Kalbitz, Kathrin Marx, Nils Kellner, Annette Glas, Maike Fedders, Christoph Lübbert

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引用次数: 0

Abstract

Purpose: To analyze the associations between adherence to quality indicators (QIs) in the treatment of bloodstream infections caused by methicillin-susceptible Staphylococcus (S.) aureus (MSSA) and in-hospital mortality.

Methods: A retrospective observational study was conducted in patients admitted between 2019 and 2023 to Hospital St. Georg in Leipzig, Germany, with at least one positive blood culture for S. aureus. Ten QIs were categorized into four groups based on blood culture results, echocardiography, antibiotic treatment, and other parameters such as infectious disease (ID) specialist consultation. Propensity score (PS) matching was used to compare in-hospital mortality between MSSA patients treated with flucloxacillin and those treated with cefazolin. Multivariate Cox regression analysis was performed to determine risk factors associated with in-hospital mortality.

Results: Of the 637 patients with S. aureus bloodstream infections, 495 patients with MSSA infection (77.8%) were included in the study. After the introduction of mandatory ID consultation in 2020, the median QI score increased to 9 out of a maximum of 10 points and was significantly higher in surviving cases than in fatal cases in subsequent years. There was a non-significant decrease in in-hospital mortality from 2019 (28.8%) to 2023 (22.7%) (p = 0.432). Based on PS matching, cefazolin had a favorable hazard ratio of 0.44 (95% CI 0.28-0.71; p < 0.001) for in-hospital mortality. The results of multivariate Cox regression analysis showed a significantly higher survival rate in patients who received QI-based management, including transesophageal echocardiography and antibiotic therapy initiated within 24 h.

Conclusions: ID consultation is associated with better adherence to quality improvement measures. Targeted MSSA therapy with cefazolin, early initiation of antibiotic therapy, and adherence to antimicrobial treatment protocols increased survival rates in our study setting.

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.