ID consult shortens antibiotics for uncomplicated gram-negative bacteremia
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Key takeaways:
- Mandatory ID consultations can reduce antibiotic courses for patients with gram-negative bacteremia.
- A consensus approach among ID doctors in a facility dramatically improved results.
HOUSTON — Consulting with an infectious disease physician can shorten antibiotic prescriptions for uncomplicated gram-negative bacteremia and move patients from IV to oral antibiotics more quickly, according to a study.
The study, presented at the Society of Healthcare Epidemiologists of America Spring Conference, found that after instituting a mandatory ID consult for three types of gram-negative bacteremia (GNB), having the ID team develop consistent methods for treatment and management of patients is essential for its success.
ID consults have been shown to improve health outcomes and shorten hospital stays for patients with bacteremia, and to have a similar impact on many other conditions.
“We were originally seeking approval from our physician practice counsel to have a mandatory policy around Staph aureus bacteremia, but our counsel actually encouraged us to include as many patients as we could,” Mary Acree, MD, an infectious diseases specialist for Endeavor Health NorthShore hospitals in Illinois, told Healio.
“We thought, we’ll start with gram negatives, Candida and Staphylococcus aureus, and then we wanted to look to see if we could safely shorten the duration of therapy for patients with gram-negative bacteremia because there’s been a lot published about that recently,” she said.
Acree and colleagues analyzed data collected between Jan. 1, 2018, and Dec. 31, 2021, from 1,026 patients hospitalized in the NorthShore University Health System in Chicago with an uncomplicated bloodstream infection due to Escherichia coli, Klebsiella species or Proteus species.
The researchers divided the study into three time periods: one before mandatory ID consultation, one after mandatory ID consultation was put in place, and one after the ID division reached a consensus for treatment of GNB, according to the study.
Among the patients, 75.4% were hospitalized with E. coli, 18.8% were infected with a Klebsiella species and 5.9% were infected with a Proteus species.
Although length of stay, 30-day readmission and in-hospital mortality were not statistically significantly different before or after the ID consult requirement was put in place, the total duration of therapy among patients was significantly shorter after consultations became standard.
Acree said that once ID doctors had developed a consensus approach for treatment, “it really moved the needle” as duration of therapy shrank.
“The take-home message from the paper is that if you ask ID to see every patient with gram-negative bacteremia, you also want to make sure that ID is getting on the same page on how to manage those patients,” Acree said.
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Acree M, et al. Abstract 308. Presented at: Society for Healthcare Epidemiology of America Spring Conference; April 16-19; Houston.
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