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Comment & Response
February 2018

Immortal Time Bias in Assessing Evidence-Based Care Processes for Staphylococcus aureus Bacteremia

Author Affiliations
  • 1Victorian Infectious Disease Service, The Royal Melbourne Hospital, and The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Victoria, Australia
  • 2Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
JAMA Intern Med. 2018;178(2):295-296. doi:10.1001/jamainternmed.2017.7947

To the Editor The Original Investigation by Goto et al1 recently published in JAMA Internal Medicine presented the analysis of an impressive data set of 36 868 Staphylococcus aureus bacteremia episodes at Veterans Health Administration hospitals. Goto et al1 reported that receipt of evidence-based care processes decreased mortality with risk-adjusted odds ratios for mortality of 0.74 (appropriate antibiotics), 0.73 (echocardiography), 0.61 (infectious diseases consultation), and 0.33 (all 3 processes). While these results are striking, we are concerned that immortal time bias has not been properly accounted for in the analysis, which may bias the results in favor of these interventions.

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