Infectious Diseases Consultation Is Associated With Decreased Mortality in Enterococcal Bloodstream Infections

Abstract

Background Enterococcus species frequently cause health care–associated bacteremia, with high attributable mortality. The benefit of consultation with infectious disease (ID) specialists has been previously illustrated with Staphylococcus aureus bacteremia. Whether ID consultation (IDC) improves mortality in enterococcal bacteremia is unknown. Methods This is a retrospective cohort single-center study from January 1, 2015, to June 30, 2016, that included all patients >18 years of age admitted with a first episode of Enterococcus bacteremia. Patients were excluded if death or transfer to palliative care occurred within 2 days of positive blood culture. Results Two hundred five patients were included in the study, of whom 64% received IDC. Participants who received IDC were more likely to undergo repeat cultures to ensure clearance (99% vs 74%; P < .001), echocardiography (79% vs 45%; P < .001), surgical intervention (20% vs 7%; P = 0.01), and have appropriate antibiotic duration (90% vs 46%; P < .001). Thirty-day mortality was significantly higher in the no-IDC group (27 % vs 12 %; P < .007). In multivariate analysis, 30-day in-hospital mortality was associated with both E. faecium bacteremia (adjusted odds ratio [aOR], 2.39; 95% confidence interval [CI], 1.09–5.23) and IDC (aOR, 0.35; 95% CI, 0.16–0.76). Conclusions Patients who received IDC for Enterococcus bacteremia had significantly lower 30-day mortality. Further prospective studies are necessary to determine if these outcomes can be validated in other institutions for patients who receive IDC with Enterococcus bacteremia.

How do I manage a patient with enterococcal bacteraemia?

“…In a single-centre study including 205 cases of EB, IDC increased the likelihood of echocardiography, follow-up blood cultures and appropriate duration of therapy. Patients in the IDC group presented significantly lower 30-day mortality rates [46]. Moreover, a recent Italian experience supported the whole 'bundle approach', showing a significantly lower 30-day mortality in patients managed with systematic care bundle consisting of targeted antibiotic therapy guided by IDC, follow-up blood cultures monitoring and echocardiography than in patients managed according to the standard of care (20% vs. 32%, p 0.003) [47].…”

The Effect of Nomenclature Revision of Streptococcus bovis to Streptococcus gallolyticus on Subsequent Colon Cancer Screening

“…After exclusion of 121 patients who had died in the first 14 days, there was a significant decrease in overall mortality of the 1060 remaining patients if they had evidence of intent for colonoscopy, GI consultation, ID consultation, or any consultation compared with those patients who did not, suggesting that ID and GI consultations in patients with S. bovis / S. gallolyticus bacteremia are associated with lower mortality. ID consultation has been illustrated to decrease mortality in patients suffering from a number of infections such as those caused by multidrug-resistant organisms [ 13 ] and Staphylococcus aureus [ 14 ] and in enterococcal bacteremias [ 15 ]. Though we did not investigate specific causes of mortality, based on these studies, appropriate antimicrobial agent use, duration of therapy, and identification and control of the source of bacteremia may explain this finding.…”

The Rates of the Unnecessary Antimicrobial Use (UAU) and the Effect of the Infectious Disease Consultations: A Cross-Sectional Study

“…The other specialties did not significantly differ between the two categories. Furthermore, a notable (P<0.05) decrease in the mortality for patients cared for by infectious disease physicians, a phenomenon that keeps on echoing [31][32][33], oncologists (as admitting physicians) shared the infectious diseases physicians the lower mortality, however, oncologists regularly consult infectious diseases for suspected sepsis/sepsis in the three medical centers (Table 4).…”