Infectious Diseases Consultation Lowers Mortality From Staphylococcus aureus Bacteremia

Abstract

Staphylococcus aureus bacteremia (SAB) is a lethal and increasingly common infection in hospitalized patients. We assessed the impact of infectious diseases consultation (IDC) on clinical management and hospital mortality of SAB in 240 hospitalized patients in a retrospective cohort study. Patients who received IDC were older than those who did not (57.9 vs. 51.7 yr; p = 0.05), and were more likely to have a health care-associated infection (63% vs. 45%; p < 0.01). In patients who received IDC, there was a higher prevalence of severe complications of SAB such as central nervous system involvement (5% vs. 0%, p = 0.01), endocarditis (20% vs. 2%; p < 0.01), or osteomyelitis (15.6% vs. 3.4%; p < 0.01). Patients who received IDC had closer blood culture follow-up and better antibiotic selection, and were more likely to have pus or prosthetic material removed. Hospital mortality from SAB was lower in patients who received IDC than in those who did not (13.9% vs. 23.7%; p = 0.05). In multivariate survival analysis, IDC was associated with substantially lower hazard of hospital mortality during SAB (hazard 0.46; p = 0.03). This mortality benefit accrued predominantly in patients with methicillin-resistant SAB (hazard 0.3; p < 0.01), and in patients who did not require ICU admission (hazard 0.15; p = 0.01). In conclusion, IDC is associated with reduced mortality in patients with staphylococcal bacteremia.

Clinical Impact of a Real-Time PCR Assay for Rapid Identification of Staphylococcal Bacteremia

“…Anecdotally, infectious-disease physicians were more likely to respond to the PCR assay, suggesting that physicians who were more familiar with molecular diagnostic tests were more likely to use the result to guide antibiotic therapy decisions. In our view, the effect of infectious-disease consultation should not be underestimated: in previous studies, involvement of infectious-disease physicians was associated with reduced mortality in patients with S. aureus bacteremia in the absence of rapid diagnosis (6,10). Furthermore, Forrest et al have reported outcome improvements for patients with S. aureus bacteremia from the use of a rapid fluorescence in situ hybridization (FISH) test (peptide nucleic acid [PNA]-FISH) that distinguished S. aureus from coagulase-negative staphylococci (4).…”

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.…”

Influencia en la evolución de los pacientes con bacteriemia/candidemia de la participación activa del especialista clínico en Patología Infecciosa. Estudio de una cohorte prospectiva

“…Las bacteriemias por Staphilococcus aureus representan el 7% de la cohorte, y la resistencia a meticilina es menor en nuestra área a lo descrito por otros autores, pero, en general, es en las bacteriemias por estos grampositivos donde múltiples trabajos [16][17][18] han evaluado la relevancia de la valoración clínica por un consultor en Patología Infecciosa. En nuestro estudio, y dado el pequeño tamaño de esta población, no se analizó concretamente este aspecto o subgrupo de bacteriemias.…”