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ObjectivesTo analyze the adherence and impact of quality-of-care indicators (QCI) in the management of Staphylococcus aureus bloodstream infection in a prospective and multicenter cohort.MethodsAnalysis of the prospective, multicenter international ISAC cohort of SAB cases observed between January 2013 and April 2015. Multivariable analysis was performed to evaluate the impact of adherence to QCIs on 90-day mortality.ResultsA total of 1,784 cases were included. Overall, 90-day mortality was 29.9%, mean follow-up 118 days. Adherence was 67% (n=1180/1762) for follow-up blood cultures, 31% (n=416/1342) for early focus control, 77.6% (n=546/704) for performance of echocardiography, 75.5% (n=1348/1784) for adequacy of targeted antimicrobial therapy, 88.6% (n=851/960) for adequacy of treatment duration in non-complicated bloodstream infections and 61.2% (n=366/598) in complicated bloodstream infections. Full bundle adherence was 18.4% (n=328/1784). After controlling for immortal time bias and potential confounders, focus control (aHR = .76; 95% CI, .59-.99; P = .038) and adequate targeted antimicrobial therapy (aHR = .75; 95% CI, .61-.91; P = .004) were associated with lower 90-day mortality.ConclusionsAdherence to QCIs in SAB did not reach expected rates. Apart from the benefits of application as a bundle, focus control and adequate targeted therapy were independently associated with lower mortality.

Original publication




Journal article


Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases

Publication Date



Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL (Institut d´Investigació Biomèdica de Bellvitge), University of Barcelona, Barcelona, Spain.


International Staphylococcus aureus collaboration (ISAC) study group, ESCMID Study Group for Bloodstream Infections, Endocarditis and Sepsis (ESGBIES)