An Antimicrobial Stewardship Intervention Improves Adherence to Standard of Care for Staphylococcus aureus Bloodstream Infection.

INTRODUCTION: Staphylococcus aureus bloodstream infections (SABSI) are a major cause of morbidity and mortality in the United States, and proper management is important to effect cure and prevent metastatic foci of infection. We aimed to utilize our antimicrobial stewardship program (ASP) to improve practices at a large academic hospital system.

METHODS: Our ASP implemented a SABSI educational campaign directed at the hospital medicine, cardiology, and infectious diseases divisions. A stewardship intervention was then begun for all patients with SABSI recommending infectious diseases consultation, transesophageal echocardiography (TEE), source control, and preliminary antibiotic changes. A retrospective review was performed for all SABSI cases 2 years before and after implementation of the SABSI intervention.

RESULTS: Two hundred forty-three cases before intervention and 259 after intervention were included. An increase in obtaining follow-up negative blood cultures (79.8% vs. 89.6%), infectious diseases consultation (52.7% vs. 86.5%), TEE (25.5% vs. 54.8%), beta-lactam switch for methicillin-susceptible S. aureus (55.2% vs. 74.4%), and source control (41.2% vs. 57.9%) was demonstrated. We demonstrated similar durations of bacteremia, length of stay, relapse, mortality, and rates of infective endocarditis.

CONCLUSIONS: Adherence to standard of care for patients with SABSI can be dramatically improved through provider education, leveraging antimicrobial stewardship resources, and infectious diseases consultation.