Impact of Infectious Diseases Consultation on the Treatment of Staphylococcus aureus Bacteremia

Abstract

Background This study assessed the impact of infectious diseases consultation (IDC) on 30-day readmission rates in patients with Staphylococcus aureus bacteremia (SAB). Furthermore, this study also evaluated the effect of IDC on adherence to guideline-directed therapy. Methods This retrospective cohort study enrolled 149 adult patients with SAB. Cohort 1 included 28 patients without IDC. Cohort 2 included 121 patients with IDC. Primary end point was all-cause 30-day readmission rates. Secondary outcomes included adherence to guideline-directed therapy and hospital length of stay (LOS). Guideline-directed therapy included repeat blood cultures until blood sterility, assessment for an echocardiogram, and appropriateness of antimicrobial therapy (including antibiotic, dose, and duration). Results Readmission rates were 46.4% (13/28) without IDC and 19% (23/121) with IDC (P = 0.006). Guideline-directed therapy occurred in 21.4% (6/28) without IDC versus 96.7% (117/121) with IDC (P = 0.0001). The average LOS was shorter without IDC than with IDC (5.6 vs 7.8 days, respectively; P = 0.01). The most common reasons for lack of guideline adherence in the control group were lack of echocardiogram (72.4%) and lack of repeat blood cultures (51.7%). Multivariate analysis demonstrated that only lack of IDC significantly affected readmission rates (odds ratio, 3.51; 95% confidence interval, 1.48–8.52; P = 0.0048). Conclusions Consultation with infectious diseases reduces 30-day readmission rates in patients with SAB and increases adherence to guideline-directed therapy; however, LOS was increased. Infectious diseases consultation should be considered for all patients with SAB.

Expert consensus recommendations for the provision of infective endocarditis services: updated guidance from the Joint British Societies

“…Analysis of a period of ID review of all bacteraemic patients compared with a prior period without consultation was associated with increased diagnosis of IE, although this study was at high risk of bias 19. In single-centre cohort studies of patients with S. aureus bacteraemia, ID consultation was associated with higher rates of echocardiography in two studies20 21 and lower mortality rates in one 20. Similarly, in a retrospective cohort study of patients with at least one blood culture positive for Enterococcus spp., patients with an ID consultation were more likely to undergo repeat cultures to ensure clearance (99% vs 74%, p<0.001), echocardiography (79% vs 45%, p<0.001), surgical intervention (20% vs 7%, p=0.01) and receive antibiotics for an appropriate duration (90% vs 46%, p<0.001) 22…”