A team of researchers led by Dr. Michihiko Goto within the VA’s Comprehensive Access & Delivery Research & Evaluation (CADRE) has just completed a study of the largest cohort of individuals infected with Staphylococcus aureus bacterium (SAB) ever. The team’s resulting article on their findings appears this week in JAMA Internal Medicine.
SAB infections have become one of the most common and costly and often result in poor outcomes for the infected. Despite the awareness of the problem, care providers have struggled to develop and implement consistent protocols, in part because of a paucity of evidence-based studies to demonstrate effective prevention and treatment methods. Dr. Goto and his CADRE colleagues aimed to fill that gap.
The researchers examined whether nearly 37,000 VHA patients infected with SAB, seen between 2003 and 2014, received three specific types of care after infection and what impact those interventions had on mortality rate. A combination of all three—consults from infectious diseases specialists, appropriate antibiotic administration, and an echocardiograph to identify the presence of endocarditis—was strongly associated with the greatest reductions in the 30-day mortality rate. In cases where all three were used, odds of mortality were approximately 65% lower than in cases where none was used.
“We think that this builds a strong case for quality metrics around SAB,” Dr. Goto said. By gaining access to the wealth of material that exists within the VHA’s databases, the CADRE team could examine patient data—de-identified—which revealed detailed records of courses of treatment, numbers of visits, medications prescribed, and much more, stretching back decades. Dr. Goto and his team focused specifically on just whether those three evidence-based care processes were implemented for veterans infected in that nearly twelve-year window.
By finding links between these methods and a reduction in patient mortality rate, Dr. Goto hopes this could produce a shift in how SAB infections are handled. “This study shows actual outcomes are possible to be found, which should provide incentives to hospitals to implement these care processes.” In the meantime, CADRE continues its work with this data, looking for additional patterns and signs of hope against a persistent and growing threat.
Contributing authors from the department and CADRE include senior author Dr. Michael Ohl, Dr. Marin Schweizer, Dr. Mary Vaughan-Sarrazin, Dr. Eli Perencevich, Dr. Dan Livorsi, Dr. Dan Diekema, Dr. Kelly Richardson, Brice Beck, and Bruce Alexander.