Impact of a pharmacist-facilitated, evidence-based bundle initiative on Staphylococcus aureus bacteremia management

Diagn Microbiol Infect Dis. 2021 Dec;101(4):115535. doi: 10.1016/j.diagmicrobio.2021.115535. Epub 2021 Sep 4.

Abstract

Objective: To evaluate a pharmacist-facilitated evidence-based bundle (EBB) initiative with infectious disease consultation (IDC) for Staphylococcus aureus bacteremia (SAB).

Methods: This was a before-and-after quasi-experimental study of adult patients with SAB before and after the pharmacist-facilitated EBB initiative, which included IDC, timely definitive antibiotics, source control, echocardiography, and repeat blood cultures.

Results: Ninety and 111 patients were included in pre- and post-intervention cohorts, respectively. We observed significant increases in adherence to all 5 (4.4% vs 68.5%, P < 0.001) and 4 (10.0% vs 76.6%, P < 0.001) EBB elements. Time to definitive antibiotics (48 vs 16 hours, P < 0.001), time to IDC (43.5 vs 32 hours, P < 0.001), SAB duration (95 vs 66 hours, P = 0.009), persistent SAB (18.9% vs 9.0%, P = 0.041), and length of stay (14 vs 13 days, P = 0.027) also improved. No statistically significant differences for SAB-related readmission or all-cause mortality were observed.

Conclusions: Our pharmacist-facilitated SAB initiative was associated with improved EBB adherence and clinical outcomes.

Keywords: Antimicrobial stewardship; Bacteremia; Bundle; Pharmacist; Staphylococcus aureus.

MeSH terms

  • Adult
  • Anti-Bacterial Agents / therapeutic use*
  • Antimicrobial Stewardship
  • Bacteremia / drug therapy*
  • Bacteremia / microbiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Care Bundles*
  • Patient Compliance
  • Pharmacists*
  • Referral and Consultation
  • Staphylococcal Infections / drug therapy*
  • Staphylococcal Infections / microbiology
  • Staphylococcus aureus / drug effects
  • Staphylococcus aureus / isolation & purification
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents