Staphylococcus Aureus Bacteremia: Impact of an Intervention Program in Improving the Clinical Management and Review of the Clinical and Molecular Epidemiology

Study Overview
=================
Brief Summary
-----------------
Staphylococcus aureus bacteremia: impact of an intervention program in improving the clinical management and review of the clinical and molecular epidemiology.

Official Title
-----------------
Staphylococcus Aureus Bacteremia: Impact of an Intervention Program in Improving the Clinical Management and Review of the Clinical and Molecular Epidemiology

Conditions
-----------------
Staphylococcus Aureus Bacteremia

Intervention / Treatment
-----------------
* Behavioral: Follow recommendations based on scientific evidence to S. aureus bacteremia management
* Behavioral: Not to follow recommendations based on scientific evidence to S. aureus bacteremia management


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients over 14 Clinical significant bacteremia by S. aureus Patient hospitalized Exclusion Criteria: Non clinical significant bacteremia Ambulatory patient End-of-life patients

Ages Eligible for Study
-----------------
Minimum Age: 14 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients diagnosed bacteremia by S. aureus<br> | Behavioral: Follow recommendations based on scientific evidence to S. aureus bacteremia management<br> <br> Behavioral: Not to follow recommendations based on scientific evidence to S. aureus bacteremia management<br> <br> |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The overall target is to assess if the implementation of an active intervention program improves clinical management of the disease, according to existing recommendations. | Identify evidence-based quality-of-care indicators (QCIs) for the management of Staphylococcus aureus bacteremia (SAB). See secondary objective for the definitions of QCIs | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Follow-up blood cultures performance of control blood culture 48-96h. | Description:Performance of control blood cultures 48-96 h after antimicrobial therapy was started regardless of clinical evolution Formula:Patients with follow-up blood culture collected×100/Patients alive at 96h. | 6 months | 
| Early source control | Description: Removal of nonpermanent vascular catheter whenever the catheter was suspected or confirmed as the source of SAB, or drainage of an abscess in <72 h. Formula: Patients in which the amenable source was removed in<72h×100/Patients with source amenable of removal/drainage | 6 months | 
| Echocardiography in patients with clinical indications | Description: Performance of echocardiography in patients with complicated bacteremia or predisposing conditions for endocarditis. Formula: Patients with echocardiography×100/Patients with complicated bacteremia or predisposing condition for endocarditis,alive at 96h | 6 months | 
| Early use of IV cloxacillin for meticillin susceptible Staphylococcus aureus as definitive therapy | Description: Definitive therapy with intravenous cloxacillin (at least 2 g every 6 h or adjusted based on renal function in renal failure) in cases of methicillin-susceptible strains (allergic patients excluded). Treatment should be started within the first 24 h after methicillin sensitivity was available. For hemodialysis patients, cefazolin 2 g after each hemodialysis session was acceptable Formula: Definitive therapy with IV cloxacillin×100/nonallergic Patients with methicillin-susceptible isolates. | 6 months | 
| Adjustment of vancomycin dose according to trough levels. | Description: Measurement of trough levels of vancomycin in patients treated for at least 3 d with this antibiotic and adjustment of dose in order to achieve plasma trough levels between 15 and 20 mg/L in survivors Formula: Patients with trough level of vancomycin determined and dose adjusted×100/Patients treated with vancomycin,at 3d. | 6 months | 
| Treatment duration according to the complexity of infection. | Description: Duration of antimicrobial therapy of at least 14 d for uncomplicated bacteremia and 28 d for complicated bacteremia. Sequential oral treatment with fluoroquinolone plus rifampin, trimethoprim-sulfamethoxazole, or linezolid was considered accepted in selected case. Formula:Patients with appropriate duration of therapy×100/P alive at 14 or 28d in uncomplicated or complicated bacteremia | 6 Months | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
multiresistant bacteremia, bacteremia management, blood culture