841. Impact of routine bedside infectious diseases consultation on clinical management and outcome of Staphylococcus aureus bacteraemia in adults
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 9, 2015
Room: Poster Hall
Background: Staphylococcus aureusbacteraemia (SAB) is a common, serious infection with mortality rates of up to 40%. Previous retrospective studies have shown improvements in the clinical management and outcome of patients with bacteraemia who receive infectious diseases consultation (IDC).  In the United Kingdom, the management of SAB varies widely between different hospitals. The aim of this study was to evaluate whether the introduction of routine bedside IDC service for adults with SAB resulted in improvements in management and outcome.

Methods: We conducted observational cohort study of adults with SAB  at the Cambridge University Hospitals NHS Foundation Trust between July 2006 and December 2012. A telephone consultation was provided on the day of positive blood culture in all cases. For patients admitted between July 2006 and November 2009 (the pre-IDC group), data were collected retrospectively from the medical records and a national register of deaths. From November 2009 all patients with SAB received an initial bedside clinical review, followed by weekly clinical review by the IDC team until the time of hospital discharge (the routine IDC group). Data were collected prospectively in this group. Outcome measures included quality indicators for the management of SAB, and death or recurrent bacteraemia at 30 and 90 days.,

Results: There were 571 adults with SAB between July 2006 and December 2012; 94 were excluded from the analysis. Patients in the routine IDC group (N=183) were more likely to have a removable focus of infection identified, echocardiography performed, and follow-up blood cultures taken than patients in the pre-IDC group (N=294). They also received longer courses of antimicrobial therapy, were more likely to receive combination antimicrobial therapy, and to have SAB recorded in the hospital discharge summary. There was a trend towards lower mortality at 30 days in the routine IDC group compared to pre-IDC group (12% versus 22%, P=0.07).

Conclusion: Our study findings suggest that routine bedside IDC should become the standard of care for adults with SAB.

Rebecca Saunderson, BMedSci MBBS MPhil1, Theodore Gouliouris, BM BCh2, Emma Nickerson, MBBS PhD3, Edward Cartwright, MBBS PhD2, Angela Kidney, BSc2, Sani Aliyu, MBBS FRCP FRCPath4, Nicholas Brown, MBBS FRCPath5, Direk Limmathurotsakul, MD PhD6, Sharon Peacock, PhD FRCP FRCPath2 and Estee Torok, PhD FRCP FRCPath2, (1)Department of Dermatology, Royal North Shore Hospital, St Leonards, Australia, (2)Department of Medicine, University of Cambridge, Cambridge, United Kingdom, (3)Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom, (4)Department of Infectious Diseases and Microbiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom, (5)Department of Microbiology, Public Health England, Cambridge, United Kingdom, (6)Faculty of Tropical Medicine, Mahidol Oxford Research Unit, Bangkok, Thailand

Disclosures:

R. Saunderson, None

T. Gouliouris, None

E. Nickerson, None

E. Cartwright, None

A. Kidney, None

S. Aliyu, None

N. Brown, None

D. Limmathurotsakul, None

S. Peacock, None

E. Torok, None

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