Program Schedule

722
Infectious Diseases Consultation Increases Adherence with Quality of Care Indicators for Management of Staphylococcus aureus Bacteremia

Session: Poster Abstract Session: Bacteremia: Staphylococcal Bacteremia
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • IDSA 2014 SAB poster Manjit Singh Dhillon MD FACP-2.pdf (579.1 kB)
  • Background: Adherence to evidence-based quality of care indicators in treatment of Staphylococcus aureus bacteremia (SAB) has been shown to improve clinical outcomes. We studied the effect of Infectious Diseases (ID) consultation on adherence to established quality of care indicators for management of SAB.

    Methods: Using a retrospective study design, we conducted chart reviews on all patients who were managed for SAB at Vidant Medical Center and affiliated community hospitals during a one-year period (November, 2012 to November, 2013).  Subjects were divided into two groups: those who received ID consultations and those who did not. Information on demographics, quality-of-care indicators, and clinical outcomes were obtained. Fisher’s exact test and chi square analysis were used to assess differences in the two groups with p<0.05 denoting statistical significance.

    Results: Of 182 patients with SAB, 84 patients (mean age 51, 59.5% male, 47.6% Caucasian) had ID consultation and 98 (mean age 56, 60.4% male, 38.7% Caucasian) did not receive ID consultation. Methicillin-sensitive Staphylococcus aureus (MSSA) were identified in 55.9% of patients in ID consultation and 61.2% in non-ID consultation group (p=0.56). As compared to the non-ID consultation group, patients in the ID consultation group were more likely to have repeat blood cultures within 96 hours (86.9% vs. 69.3%, p=0.008), have an echocardiogram (92.8% vs. 62.2%, p<0.0001), and receive appropriate antibiotics in terms of duration and choice (100%, vs. 76.5%, p<0.0001). Also, patients in the ID consultation group were more likely to have early de-escalation (within 24 hours) to nafcillin or cefazolin (from vancomycin or daptomycin) in cases of MSSA bacteremia (89.3% vs. 71.6%, p=0.03). Recurrences of bacteremia within 90 days were similar in both groups (73.8% vs. 69.3%, p=0.2). There was a trend towards decreased all-cause mortality during the initial admission in ID consultation group (9.5% vs. 20.4%, p=0.06).

    Conclusion: ID consultation increases adherence with evidence-based quality of care indicators, leads to more appropriate antimicrobial therapy, and can improve patient outcomes during management of SAB. Clinicians should consider getting ID consultation for all patients with SAB.

    Manjit Dhillon1, Kaushal Shah, MD2, Muhammad Salman Ashraf, MD3, Hao Nguyen, MD4 and Paul Cook, MD1, (1)Infectious Diseases, East Carolina University, Greenville, NC, (2)Infectious Disease, East Carolina University/ Vidant Medical Center, Greenville, NC, (3)Infectious Disease, Brody School of Medicine, East Carolina University, Greenville, NC, (4)Internal Medicine- Infectious Diseases Division, East Carolina University- Brody School of Medicine, Greenville, NC

    Disclosures:

    M. Dhillon, None

    K. Shah, None

    M. S. Ashraf, None

    H. Nguyen, None

    P. Cook, Forest: Gilead (investigator), Pfizer (investigator), Merck (investigator and speakersí bureau) and Forest, Speaker honorarium

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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