Infectious Diseases Consultation Increases Adherence with Quality of Care Indicators for Management of Staphylococcus aureus Bacteremia
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.
M. S. Ashraf, None
H. Nguyen, None
P. Cook, Forest: Gilead (investigator), Pfizer (investigator), Merck (investigator and speakersí bureau) and Forest, Speaker honorarium