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Survival following Staphylococcus aureus bloodstream infection; a prospective multinational cohort study assessing the impact of place of care

Nambiar, K; Siefert, H; Rieg, S; Kern, WV; Scarborough, M; Gordon, NC; Kim, BN; ... Kaasch, A; + view all (2018) Survival following Staphylococcus aureus bloodstream infection; a prospective multinational cohort study assessing the impact of place of care. Journal of Infection , 77 (6) pp. 516-525. 10.1016/j.jinf.2018.08.015. Green open access

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Abstract

BACKGROUND: Staphylococcus aureus bloodstream infection (SAB) is a common, life-threatening infection with a high mortality. Survival can be improved by implementing quality of care bundles in hospitals. We previously observed marked differences in mortality between hospitals and now assessed whether mortality could serve as a valid and easy to implement quality of care outcome measure. METHODS: We conducted a prospective observational study between January 2013 and April 2015 on consecutive, adult patients with SAB from 11 tertiary care centers in Germany, South Korea, Spain, Taiwan, and the United Kingdom. Factors associated with mortality at 90 days were analyzed by Cox proportional hazards regression and flexible parametric models. RESULTS: 1851 patients with a median age of 66 years (64% male) were analyzed. Crude 90-day mortality differed significantly between hospitals (range 23–39%). Significant variation between centers was observed for methicillin-resistant S. aureus, community-acquisition, infective foci, as well as measures of comorbidities, and severity of disease. In multivariable analysis, factors independently associated with mortality at 90 days were age, nosocomial acquisition, unknown infective focus, pneumonia, Charlson comorbidity index, SOFA score, and study center. The risk of death varied over time differently for each infective focus. Crude mortality differed markedly from adjusted mortality. DISCUSSION: We observed significant differences in adjusted mortality between hospitals, suggesting differences in quality of care. However, mortality is strongly influenced by patient mix and thus, crude mortality is not a suitable quality indicator.

Type: Article
Title: Survival following Staphylococcus aureus bloodstream infection; a prospective multinational cohort study assessing the impact of place of care
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.jinf.2018.08.015
Publisher version: https://doi.org/10.1016/j.jinf.2018.08.015
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Bacteremia, Quality measures, Staphylococcus aureus, Observational study, Mortality
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10054955
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