Close cooperation between infectious disease physicians and attending physicians can result in better management and outcome for patients with Staphylococcus aureus bacteraemia

Abstract

Staphylococcus aureus bacteraemia (SAB) is a serious infection that demands prompt clinical attention for good outcome. To assess the impact of intervention by infectious diseases physicians (IDPs) in cases with SAB, a retrospective cohort study of patients with SAB was performed in a 1240-bed, university hospital in Japan, with the aim of comparing the management and outcome of patients during the initial and the latter half of the intervention period,. Three hundred and forty-six patients with SAB during the 7-year period, from 2002 to 2008, were included, and 194 patients in the initial half of the period (from 2002 to 2005) were compared with 152 patients in the later period (from 2006 to 2008). There was no significant difference between the two groups with respect to patient's clinical background, although more patients in the later period were receiving immunosuppressive treatment. The proportion of methicillin resistant S. aureus was lower during the later period (56.2% vs. 43.3%; p 0.02). Echocardiography was used more frequently (37.1% vs. 64.5%; p < 0.001). Infective endocarditis and metastatic infections were diagnosed more frequently (10.8% vs. 20.4%; p 0.01). Follow-up blood cultures were obtained more regularly (52.1% vs. 73.7%; p <0.001) and therapy was more frequently administered for at least 14 days (47.4% vs. 82.2%; p <0.001). The 30-day mortality improved during the intervention period (25.8% vs. 16.4%; p 0.04). The total number of blood cultures received by the laboratory increased annually and the total number of consultations increased by approximately 1.6-fold compared to 2002. Proactive intervention by IDPs raised awareness of optimal management of bacteraemia and improved the adherence to the standards of care, which subsequently resulted in an improvement in the outcome.

Clinical Management ofStaphylococcus aureusBacteremia

“…All found clinical benefit; 11 reported improved mortality among patients who received IDC. 83–93 IDC was also associated with increased adherence to standards of care, including selection of a β-lactam for MSSA infections, 84–88,94,95 longer duration of therapy for complicated infection, 83–88,92,94,95 removal of intravenous catheters, 84,94 obtaining follow-up blood cultures to assess for clearance of bacteremia, 84,85,87,88,92–94 obtaining echocardiography, 83,85,86,88,93,96 draining abscesses, 84 and removing infected prosthetic material. 84,95 Thus, while the evidence for routine IDC in patients with SAB is limited to observational studies, it supports the conclusion that IDC should be considered for every case of SAB at institutions where such expertise is available.…”

Pattern of bacterial and fungal infections in the first 3 months after pediatric living donor liver transplantation: An 11-year single-center experience

“…Minimization of SSI can be achieved by refinement of surgical technique 8 and direct consultation by infectious disease physicians. 16,28 Because the majority of gram-positive Enterococci and gram-negative rods in our center were previously reported to be resistant to flomoxef, which was used for postoperative prophylaxis in our center, broaderspectrum prophylaxis, if implemented, should be reassessed continually with respect to the potential for emergence of increasing antimicrobial resistance (to the prophylactic agents used). 20,29,30 Initial reports from our center and others 7,8,20,23,25,27 indicated that Candida was the most common fungal infection after LT. Those results are in accordance with our present study results.…”

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

“…obtaining an echocardiograph (69,81,83,85,87,88), (iii) removing infected foci (80,86,89), (iv) providing a longer duration of treatment for complicated SAB (80)(81)(82)(83)(84)(86)(87)(88)(89), and (v) administering ␤-lactam antibiotics for MSSA infections (80,81,83,86,88,89). Eleven studies also reported that ID consultation for SAB is associated with reduced patient mortality rates (61, 62, 80-85, 87, 88, 90).…”

“…An infectious diseases (ID) consultation can play a key role in facilitating the process of appropriate investigation and management of patients with SAB. ID consultation for patients with SAB is associated with higher rates of various quality-of-care metrics, including (i) obtaining follow-up blood cultures to assess the clearance of SAB (80)(81)(82)(83)(84)(85)(86), (ii) a The mean percentages of patients for each primary focus of infection from all the studies were as follows: 5% for infective endocarditis, 8% for osteoarticular, 19% for SSTI, 9% for pleuropulmonary, 26% for line related, 24% for no focus/unknown, and 11% for other foci. MRSA, methicillin-resistant S. aureus; HCA, health care associated; SSTI, skin and soft tissue infection.…”