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ID specialist consultation lowers mortality from some MDROs
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Consultation with ID specialists can reduce 30-day mortality rates from at least some drug-resistant pathogens by more than 50%, according to researchers.
It can also significantly reduce 1-year mortality rates for certain pathogens, they wrote in Open Forum Infectious Diseases.
“These are serious infections that anybody can get and end up in the hospital,” researcher Jason P. Burnham, MD, an instructor of medicine at the Washington University School of Medicine in St. Louis, said in a news release. “Understanding how we can help improve outcomes in patients like these is really important.”
Burnham and colleagues conducted a retrospective study of 4,214 patients who were treated for infection by multidrug-resistant organisms at Barnes-Jewish Hospital between 2006 and 2015. In particular, they assessed the records of patients with infections caused by Enterobacteriaceae, Staphylococcus aureus, Enterococcus, Pseudomonas and Acinetobacter.
The researchers found that, among patients with Enterobacteriaceae infection, ID specialist consultation was associated with a 59% decrease in 30-day mortality (HR = 0.41; 95% CI, 0.27-0.64). Similarly, it was associated with a 52% decrease in 30-day mortality among those with S. aureus infection (HR = 0.48; 95% CI, 0.36-0.63). Among patients with infections from several pathogens — all of which were multidrug resistant — ID consultation was associated with a 49% decrease in 30-day mortality (HR = 0.51; 95% CI, 0.31-0.86).
The researchers also found that including ID specialists in the initial treatment of certain infections was associated with reductions in 1-year, all-cause mortality. Specifically, it was linked to a 27% decrease among patients treated for S. aureus (HR = 0.73; 95% CI, 0.61-0.86) and a 26% decrease among those with Enterobacteriaceae (HR = 0.74; 95% CI, 0.59-0.94).
The researchers did not find similar benefit for patients with Acinetobacter or Pseudomonas infections, but they noted that these patients represented the smallest groups in the study and the samples were insufficient to determine mortality differences. They said ID consultation was “marginally associated” with a decrease in 30-day mortality among those with Enterococcus infection (HR = 0.81; 95% CI, 0.62-1.06). But that group, too, was small, and a larger sample might have produced a significant decrease, they said.
“By analyzing outcomes after ID consultation, we hope to encourage ID involvement and collaboration with teams caring for patients with MDRO infections to improve patient outcomes,” they wrote. “Our research further emphasizes the crucial role of ID physicians in the face of ever-increasing antimicrobial resistance.” – by Joe Green
Disclosures: The authors report no relevant financial disclosures.
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