Optimizing the Management of Staphylococcus Aureus Bacteremia (OPTIMUS-SAB)

Not Applicable

Recruiting

• Conditions: Staph Aureus Bacteremia

• Registration Number: NCT06338176
• Lead Sponsor: University of Alberta

Brief Summary

Staphylococcus aureus bacteremia (SAB) is associated with high morbidity and mortality rates with an incidence disproportionately higher in vulnerable populations. Management according to evidence-based care parameters, in particular Infectious Diseases (ID) consultation, is associated with improved mortality. SAB management is suboptimal in Alberta compared to other jurisdictions. An Alberta-based pilot study confirmed that timely recommendations to optimize SAB care, including ID consultation, was associated with improved adherence to all evidence-based quality-of-care indicators.

Leveraging this pilot work, the investigators aim to implement OPTIMUS-SAB, an enhanced model of the pilot, to optimize and standardize SAB management across Alberta. The implementation study will be a zone-based acute care site stepped wedge design. OPTIMUS-SAB will consist of a centralized SAB care team whom will receive automated notification of all blood cultures positive for S. aureus allowing them to review the patient's medical chart and make preliminary management recommendations according to an evidence-based care bundle.

The investigators will evaluate adherence to evidence-based SAB quality-of-care indicators before and after OPTIMUS-SAB implementation and expect this to improve with a resultant reduction in duration of bacteremia, length of stay, readmission rates, and mortality. In turn, this will translate into cost savings for the health care system.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2024-03-23
• Study First Submitted QC: 2024-03-23
• Study First Posted: 2024-03-29
• Study Start: 2024-05-01
• Status Verified: 2025-07
• Last Update Submitted: 2025-07-03
• Last Update Posted: 2025-07-08
• Primary Completion: 2025-10-30
• Study Completion: 2026-04-30

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 1800

Inclusion Criteria

• Age greater than 18 years at the time of hospital admission
• Confirmed S. aureus bacteremia by blood culture performed at a laboratory in Alberta, Canada
• Admitted to a designated acute care site in Alberta, Canada

Exclusion Criteria

• The treating team believes death is imminent or inevitable .
• GCD are C-level within 48 hours of admission.
• The patient is transferred in from an out-of-province acute care center with a pre-existing SAB diagnosis.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SEQUENTIAL

Primary Outcome Measures

Name	Time	Method
Adherence to quality-of-care indicators	Within 90 days	Defined as: 1. ID involvement and time to ID involvement, defined by the presence of an ID consult note and/or recommendations in the chart.; 2. Repeat blood cultures, to document clearance of bacteremia, within 72 hours from the last positive blood culture.; 3. Guideline-concordant empiric antibiotic administered and time to receipt.; 4. Guideline concordant definitive antibiotic administered and time to receipt.; 5. Therapeutic drug monitoring of patents treatments with vancomycin.; 6. Appropriate dose adjustment of antimicrobials based on renal function according to local guidelines.; 7. Echocardiogram (transthoracic or transesophageal) performed within 72 hours of diagnosis.; 8. Source control achieved.; 9. Appropriate duration of antibiotic therapy ordered and delivered.

Secondary Outcome Measures

Name	Time	Method
In hospital mortality	90 days	death within hospital stay
Costing evaluation	One year	Cost of SAB treatment related to hospitalization, including physician provision of care, and antibiotics.
Implementation evaluation	3 years	User experience and feedback from patients and providers will be collected at the start and end of each active implementation phase. This information will be paired with assessments of barriers, facilitators, and contextual factors informed by the Consolidated Framework for Implementation Research (CFIR) and Normalization Process Theory during the pre-implementation phase and at the end of active implementation.
Hospital re-admission rates	90 days	re-admission to acute care rate
All-cause mortality	180 days	death from any cause
Length of stay	180 days maximum	Acute hospital length of stay

Trial Locations

Locations (101)

Athabasca Healthcare Centre; 🇨🇦 Athabasca, Alberta, Canada

Mineral Springs Hospital; 🇨🇦 Banff, Alberta, Canada

Barrhead Healthcare Centre; 🇨🇦 Barrhead, Alberta, Canada

Bassano Health Centre; 🇨🇦 Bassano, Alberta, Canada

Beaverlodge Municipal Hospital; 🇨🇦 Beaverlodge, Alberta, Canada

Oilfields General Hospital; 🇨🇦 Black Diamond, Alberta, Canada

Bonnyville Healthcare Centre; 🇨🇦 Bonnyville, Alberta, Canada

Bow Island Health Centre; 🇨🇦 Bow Island, Alberta, Canada

Boyle Healthcare Centre; 🇨🇦 Boyle, Alberta, Canada

Brooks Health Centre; 🇨🇦 Brooks, Alberta, Canada

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