Infectious Diseases Consultation Reduces 30-Day and 1-Year All-Cause Mortality for Multidrug-Resistant Organism Infections

Abstract

BackgroundMultidrug-resistant organism (MDRO) infections are associated with high mortality and readmission rates. Infectious diseases (ID) consultation improves clinical outcomes for drug-resistant Staphylococcus aureus bloodstream infections. Our goal was to determine the association between ID consultation and mortality following various MDRO infections.MethodsThis study was conducted with a retrospective cohort (January 1, 2006–October 1, 2015) at an academic tertiary referral center. We identified patients with MDROs in a sterile site or bronchoalveolar lavage/bronchial wash culture. Mortality and readmissions within 1 year of index culture were identified, and the association of ID consultation with these outcomes was determined using Cox proportional hazards models with inverse weighting by the propensity score for ID consultation.ResultsA total of 4214 patients with MDRO infections were identified. ID consultation was significantly associated with reductions in 30-day and 1-year mortality for resistant S. aureus (hazard ratio [HR], 0.48; 95% confidence interval [CI], 0.36–0.63; and HR, 0.73, 95% CI, 0.61–0.86) and Enterobacteriaceae (HR, 0.41; 95% CI, 0.27–0.64; and HR, 0.74; 95% CI, 0.59–0.94), and 30-day mortality for polymicrobial infections (HR, 0.51; 95% CI, 0.31–0.86) but not Acinetobacter or Pseudomonas. For resistant Enterococcus, ID consultation was marginally associated with decreased 30-day mortality (HR, 0.81; 95% CI, 0.62–1.06). ID consultation was associated with reduced 30-day readmission for resistant Enterobacteriaceae.ConclusionsID consultation was associated with significant reductions in 30-day and 1-year mortality for resistant S. aureus and Enterobacteriaceae, and 30-day mortality for polymicrobial infections. There was no association between ID consultation and mortality for patients with resistant Pseudomonas, Acinetobacter, or Enterococcus, possibly due to small sample sizes. Our results suggest that ID consultation may be beneficial for patients with some MDRO infections.

Evaluation of the INCREMENT-CPE, Pitt Bacteremia and qPitt Scores in Patients with Carbapenem-Resistant Enterobacteriaceae Infections Treated with Ceftazidime–Avibactam

“…All patients in our study were managed by the infectious diseases consult service. The value of specialist involvement in the management of multidrug-resistant infections is well established [27][28][29][30][31].…”

Managing All the Genotypic Knowledge: Approach to a Septic Patient Colonized by Different Enterobacteriales with Unique Carbapenemases

“…Instituting a timely and effective empirical regimen can be a challenge in patients colonized with MDROs and highlights the growing need to educate primary providers on resistance and when to seek help. Retrospective studies of staphylococcal bacteremia and severe MDRO infections have demonstrated that consulting ID specialists is associated with better outcomes and decreased mortality (19,20). In this particular case, consultation with ID specialists earlier in the hospital stay may have influenced the selection of therapy to manage the first episode of bacteremia, caused by a pan-susceptible E. coli.…”

68 Consecutive patients assessed for COVID-19 infection; experience from a UK regional infectious disease unit

“…Infection clinician time is another important resource that may not be best used in managing mild respiratory illness that meets the suspected COVID-19 case definition. In recent years, many studies have demonstrated the benefit of ID physician review in terms of clinical outcome and resource utilisation in infections such as Staphylococcus aureus bacteraemia 19,20 and resistant gram-negative infections 21 . Our findings support the assessment of, and testing for, possible COVID-19 by other cadres of healthcare workers, outside the secondary care setting, but supported by specialist physicians and hospital based further diagnostics where needed.…”