Early ID consultation for S. aureus bacteremia improves outcomes, cuts hospital stays
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An infectious disease consultation within 3 1/2 days of a diagnosis of Staphylococcus aureus bacteremia was shown in a study to increase adherence to quality care indicators and decrease hospital stays compared with a later consultation.
The study, published in Clinical Infectious Diseases, found that early ID consults increased the rate of adherence to five quality indicators for treatment of S. aureus bacteremia (SAB) by 25 percentage points, increased the rate for identification of SAB source by nearly 21 percentage points and shortened the median hospital stay of participants by more than 3 days.
“While previous studies have shown that ID consultation improves patient outcomes, none have compared outcomes on the timing of the [consult] and few studies have reported the time to ID consultation in the findings,” J. Chase Cole, PharmD, a critical care pharmacy resident at the University of Florida’s UF Health Jacksonville, and colleagues wrote.
A 2019 study found that each day a blood culture comes back positive for S. aureus, patient mortality risk increases — with risk increasing significantly on the third day.
Uncomplicated SAB is generally treated for 14 days following a negative blood culture, whereas complicated infections may need treatment for 4 to 6 weeks. In the United States, the incidence of SAB ranges from 10 to 30 per 100,000 person-years and has a fatality rate of 15% to 50%, according to a 2015 review.
Cole and colleagues screened 670 patients at UF Health Jacksonville from Jan. 1, 2015, to Jan. 1, 2020, with an initial episode of SAB and enrolled 321 participants who had an ID consult. Of these, 204 (63.6%) received an ID consult within 3 1/2 days and 117 (36.4%) received one after more than 3 1/2 days.
All five quality care indicators for SAB management — identification of the source of bacteremia within 4 days, follow-up blood cultures within 4 days, obtaining an echocardiogram within 4 days, use of parenteral therapy, and appropriate recommended treatment duration — were more likely to be followed in the early consult group compared with the late consult group (65.2% vs. 40.2%), for an unadjusted OR of 2.79 (95% CI, 1.75-4.46).
Median length of stay among study participants was shorter in the early group (13.8 days vs. 16.9 days), identifying the source of the SAB infection was more likely in the early group (79.4% vs. 58.1%) and use of appropriate antibiotics was “significantly more likely” in the early group (100% vs. 97.4%), the researchers reported.
Additionally, 30-day readmission was also “significantly lower” in the early consult group (19.1% vs. 32.5%).
“Our definition of time to ID consultation was adapted to include the utilization of rapid diagnostics,” Cole and colleagues wrote. “On average, the time to positivity is approximately 15 hours, and thus, it can be extrapolated that early consultation with the infectious diseases team should occur less than 3 days from the first positive blood culture identification of S. aureus.”
References:
- Cole JC, et al. Clin Infect Dis, 2023;doi:10.1093/cid/ciad110.
- Minejima E, et al. Clin Infect Dis. 2019;doi:10.1093/cid/ciz257.
- Tong SYC, et al. Clin Microbiol Rev. 2015;doi:10.1128/CMR.00134-14.
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