Table 3.
Process of care and therapeutic management among patients (N = 915) at 3 hospitals included in a study of Staphylococcus aureus bacteremia, Los Angeles, California, 2012-2018 a
| Item | Low SES (n = 369) | Intermediate SES (n = 294) | High SES (n = 252) | P value b |
|---|---|---|---|---|
| Infectious disease consultation | 168 (46) | 176 (60) | 191 (76) | <.001 |
| Teaching community hospital | 34/48 (71) | 73/87 (84) | 140/166 (84) | .09 |
| Academic hospital | 15/21 (71) | 16/26 (62) | 25/35 (71) | .67 |
| Teaching county hospital | 119/300 (40) | 87/181 (48) | 26/51 (51) | .10 |
| Time to infectious disease consultation from date of blood culture with positive test result for S aureus, median (IQR), d | 2 (1-5) | 2 (1-5) | 2 (1-3) | <.001 |
| Receipt of infectious disease consultation ≤2 days from date of first blood culture with positive test result for S aureus | 84/168 (50) | 92/176 (52) | 134/191 (70) | .001 |
| Source-control procedures c | ||||
| Source-control procedure performed, overall | 163/268 (61) | 153/252 (61) | 118/189 (62) | .92 |
| By source of infection | ||||
| Skin and soft-tissue infection or bone/joint infection | 80/162 (49) | 63/114 (55) | 56/109 (51) | .63 |
| Device and hardware infection | 38/48 (79) | 36/48 (75) | 30/36 (83) | .65 |
| Line or dialysis catheter infection | 45/58 (78) | 54/70 (77) | 32/44 (73) | .08 |
| Time to receive source-control procedure, median (IQR), d | 2 (1-4) | 2 (1-4) | 2 (1-5) | .58 |
| Receipt of antimicrobial agent | ||||
| Antimicrobial started on day of first positive culture | 243 (66) | 186 (63) | 149 (59) | .20 |
| Antimicrobial started on day after first positive culture | 89 (24) | 72 (24) | 62 (25) | .99 |
| Duration of inpatient therapy for SAB, median (IQR), d | 9 (6-16) | 10 (6-17) | 9 (6-16) | .35 |
| Initial anti–S aureus therapy | ||||
| Vancomycin | 111 (30) | 87 (30) | 57 (23) | .09 |
| Vancomycin and beta-lactam | 197 (53) | 142 (48) | 113 (45) | .11 |
| Daptomycin, linezolid, ceftaroline | 22 (6) | 15 (5) | 25 (10) | .06 |
| Anti–methicillin-sensitive S aureus beta-lactam | 15 (4) | 16 (5) | 15 (6) | .53 |
| Other beta-lactam | 24 (7) | 24 (8) | 35 (14) | .01 |
| Definitive therapy | ||||
| Methicillin-resistant SAB | ||||
| Vancomycin | 70 (63) | 55 (59) | 29 (44) | .046 |
| Daptomycin, linezolid, or ceftaroline | 38 (34) | 36 (39) | 35 (53) | .04 |
| Methicillin-sensitive SAB | ||||
| Anti–methicillin-sensitive S aureus beta-lactam (oxacillin, nafcillin, cefazolin) | 162 (72) | 148 (78) | 142 (79) | .15 |
| Antimicrobial prescribed at discharge | 226/358 (63) | 184/277 (66) | 178/244 (73) | .04 |
| Anti–methicillin-sensitive S aureus beta-lactam (oxacillin, nafcillin, cefazolin) | 95/226 (42) | 89/184 (48) | 93/178 (52) | .11 |
| Other beta-lactam | 19/226 (8) | 8/184 (4) | 19/178 (11) | .08 |
| Vancomycin | 49/226 (22) | 43/184 (23) | 23/178 (13) | .03 |
| Daptomycin | 16/226 (7) | 15/184 (8) | 24/178 (13) | .07 |
| Linezolid | 9/226 (4) | 9/184 (5) | 5/178 (3) | .59 |
Abbreviations: IQR, interquartile range; S aureus, Staphylococcus aureus; SAB, S aureus bacteremia; SES, socioeconomic status.
Source of data: all data were extracted from medical records at each hospital. All values are numerator/denominator (percentage) or number (percentage) unless otherwise indicated. Denominators are indicated when percentages were not based on number in the column head. Low SES includes people experiencing homelessness and SES quintile 1 (the quintile of people with the lowest SES), intermediate SES includes people in SES quintiles 2 and 3, and high SES includes people in SES quintiles 4 and 5 (the quintiles of people with the highest SES). SES classification was based on residential neighborhood defined at the 2010 census block–group level.
P values determined by using the Kruskal-Wallis test or analysis of variance for continuous variables and χ2 or Fisher exact test for categorical variables. P ≤ .05 was considered significant.
Source-control procedure refers to processes that are undertaken to eliminate the source of S aureus infection, including surgical procedures, removal of infected devices, or incision and drainage procedures.