466. Mortality Associated with Staphylococcus aureus Bacteremia; The Value of Infectious Diseases Consultation
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Staphylococcus aureus bacteremia (SAB) results in a 20% to 50% mortality. Infectious diseases (ID) consultation improved adherence to evidence-based management of SAB in previous studies, but the effect of ID consultation on mortality, independent of patient co-morbidities, is unclear.
Methods: We performed a prospective cohort study of SAB patients (pts) from 2005-2007 at a 1252-bed, tertiary hospital. Mortality 2-28days after diagnosis was determined for all pts. Risk factors for all-cause mortality were determined using Cox proportional hazard modeling.
Results: We identified 347 SAB pts and excluded 6 (1.7%) pts who died ≤ 2 days after diagnosis. Among 341 SAB pts, 189 (55%) were male gender; 196 (58%) were Caucasian; 185 (54%) had MRSA; 108 (32%) had nosocomial SAB; 71 (21%) received chronic dialysis; 231 (68%) had a central venous catheter; and median age was 56 (range 22-95). 111 (33%) pts had an ID consult. Univariate risk factors for having an ID consult were prosthetic joint [17 (15%) ID consult vs. 12 (3.5%) no consult, P=.002], metastatic infection [41 (37%) vs. 18 (7.8%), P<.001], community onset SAB [21 (19%) vs.16 (7.0%), P=.004], and prolonged SAB [43 (39%) vs. 50 (22%), P=.001]. 54 (16%) pts died within 2-28 days after diagnosis. Factors associated with mortality were ICU admission ≤ 48 hours after first (+) blood culture [adjusted hazard ratio (aHR), 4.7; 95% confidence interval (CI), 2.7-8.2], cirrhosis (aHR, 4.4; 95% CI, 2.4-8.2), and age (aHR, 1.03 per year; 95% CI, 1.00-1.04). ID consult was associated with a reduction in 2-28 day mortality (aHR, 0.4; 95% CI, 0.2-0.9).
Conclusion: Only one-third of SAB pts had an ID consult in this cohort. ID consultation for SAB was independently associated with a significant reduction in 2-28 day mortality. Routine ID consultation should be considered for SAB pts with severe clinical course or multiple co-morbidities.
Peter Brookmeyer, MD1, Hitoshi Honda, MD1, Jeffrey Jones, MD1, Melissa Krauss, MPH1, David K. Warren, MD, MPH1 and  H. Honda, None..
M. J. Krauss, None..
J. C. Jones, None..
P. K. Brookmeyer, None..
D. K. Warren, None., (1)Washington University School of Medicine, Saint Louis, MO