Quality Indicators Improve Management of Staphylococcus aureus Bacteremia

The development of quality indicators and accompanying defining conditions may highlight areas of improvement at hospital sites to enhance the management of Staphylococcus aureus bacteremia, according to study results published in the JournalofAntimicrobial Chemotherapy.

S aureus bacteremia is a leading cause of community-acquired and healthcare-associated bacteremia and can often be fatal. Many factors influence the outcome of patients with S aureus bacteremia including patient comorbidities, site of infection, setting in which infection was acquired, and resistance. However, a previous study found that differences in quality of care provided at hospitals may also play a significant role in patient outcome. Quality indicators are defined as measurable elements of practice performance for which there is evidence or consensus that they can be used to assess the quality, and hence change the quality or care provided. These quality indicators and associated defining conditions can be used to measure the quality of S aureus bacteremia management in hospitals and help highlight areas of improvement. Therefore, this study aimed to develop quality indicators for the management of hospitalized patients with S aureus bacteremia.

The study design included 4 steps. First, possible quality indicators and defining conditions were extracted from a literature review. Second, a questionnaire regarding the possible quality indicators and accompanying defining conditions was sent to experts for their review. Third, a meeting with expert panel members was held to review any quality indicators that needed further rephrasing or discussion. Fourth, a second questionnaire with the updated quality indicators and accompanying defining conditions was sent to the same experts for their review. Defining conditions were defined as conditions that help operationalize quality indicators.

This process resulted in a set of 25 quality indicators for the management of hospitalized patients with S aureus bacteremia. First, 39 potential quality indicators and defining conditions were extracted from the 13 articles including from the literature review (using MEDLINE and Embase databases) for the management of S aureus bacteremia in hospitalized patients found: 37 were process indicators and 2 were outcome indicators. These 39 quality indicators and accompanying defining conditions were then converted to the questionnaire. Second, 30 of the 33 experts recruited to participate in the study returned the questionnaire; they included 1 cardiologist, 1 nuclear medicine physician, 1 infection control and prevention specialist, 2 clinical microbiologist/infectious disease specialists, 8 clinical microbiologists, and 17 infectious disease specialists. A total of 18 quality indicators were accepted and 7 were excluded. Third, 7 Dutch panel members and 4 international panel members attended a meeting to discuss the quality indicators presented in the questionnaire that needed to be rephrased or were flagged to be up for discussion.

At this time, most of the accompanying defining conditions were also operationalized to exact time periods. And fourth, the updated QIs and accompanying DCs were converted into a second questionnaire that the same 30 experts reviewed. This resulted in a final set of quality indicators and accompanying defining conditions, which reflected the following domains: antibiotic therapy (n=7), echocardiography (n=6), source control (n=4), antibiotic dose adjustment (n=2), follow-up blood cultures (n=2), intravenous-to-oral switch (n=2), infectious disease consultation (n=1), and medical discharge report (n=1).

Overall, the study investigators concluded that, “Ultimately, use of these [quality indicators] in an infrastructure of collaborating medical specialties may contribute to decreasing the high mortality of this common infection.”

Reference

Ten Oever J, Jansen JL, van der Vaart TW, Schouten JA, Hulscher ME, Verbon A. Development of quality indicators for the management of Staphylococcusaureus bacteraemia. J Antimicrob Chemother. 2019. doi:10.1093/jac/dkz342