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ID consultation improves outcomes in patients with S. aureus bacteremia
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Patients with Staphylococcus aureus bacteremia who received an infectious disease consultation experienced an earlier discharge and lower rate of in-hospital mortality than patients who did not, according to researchers from Mount Sinai Hospital in Toronto.
“Improvement in outcome due to ID consultation is most likely multifactorial,” the researchers wrote in Clinical Infectious Diseases. “It would be difficult to discern the effect of each ID consultation–resultant change in management on outcome due to relation of one management factor with other management, ID consultation, patient characteristics, survival time and outcome.”
The researchers conducted a retrospective cohort study that included 847 consecutive patients with S. aureus bacteremia from six hospitals from April 2007 through March 2010. They evaluated patient medical records to determine patient and infection characteristics and quality measures used for infection management and whether ID consultation was used. Outcomes between patients who received an ID consultation (n = 506) and those who did not (n = 341) also were assessed.
Patients who received an ID consult were more likely to receive an echocardiogram (P < .0001), a repeat blood culture in 2-4 days (P = .0058), appropriate empiric therapy (P = .0013) and a longer duration of antibiotics (P < .0001). In a propensity score–matched analysis including 303 patients from each group, patients who received an ID consultation had a lower rate of in-hospital mortality (subdistribution HR = 0.72; 95% CI, 0.52-0.99) and a higher likelihood of being discharged alive (sHR = 1.28; 95% CI, 1.06-1.56).
“Our study adds to a growing body of evidence suggesting that ID consultation optimizes management and improves outcomes in [S. aureus bacteremia],” the researchers wrote. “However, a significant proportion of individuals do not receive ID consultation. A future challenge will be to ensure that all patients benefit from this expert advice and improved care.” – by Emily Shafer
Disclosure: The researchers report no relevant financial disclosures.
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