1439. Impact of Infectious Disease consultation on management and outcomes of Staphylococcus aureus bacteremia; comparison between Medicine, Surgery and ICU. 
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions
Saturday, October 10, 2015
Room: Poster Hall
Background: Staphylococcus aureusbacteremia (SAB) is associated with significant morbidity and mortality. Some studies have suggested improved outcomes in those patients who receive Infectious Disease (ID) consultation but it is not clear if this impact is the same for patients admitted to Medicine, Surgery or ICU. We aimed to determine the impact of ID consultation on management and outcomes of SAB between different departments in our tertiary care hospital.

Methods: This was a retrospective cohort study. We included all patients with SAB hospitalized at the University of Alberta Hospital from 2010 to 2012. We compared duration of antibiotics, evaluation by echocardiography as well as mortality at 30 and 120 days between the ID Consult (IDC) Group and No ID Consult (NIDC) Group, along with subgroup comparison of the Medicine, Surgical and ICU specialties. 

Results: A total of 342 first positive Staphylococcus aureus blood cultures were identified. 17 patients were excluded due to mortality within 2 days of positive blood culture.  203 of 325 (62%) patients received ID Consults and 122 (38%) did not. In the IDC Group, 176 out of 203 (87%) had appropriate duration of antibiotics compared to 60 of 122 (49%) in the NIDC Group, for an OR of 6.74 (95% CI 3.93 to 11.54, P<0.0001). In terms of evaluation by echocardiography, patients in the IDC Group were more likely to have an echocardiogram (trans-thorathic or trans-esophageal) performed, with an OR of 2.05 (95% CI 1.29-3.25, P=0.0024). Mortality at 30 days in the IDC Group was 10% (22/203) compared to 30% (36/120) in the NIDC Group, with an OR of 3.53 (95% CI 1.95-6.36, P< 0.0001). At 120 days, the mortality difference persisted OR 3.15 (95% CI 1.91-5.22, P<0.0001). These differences were seen across all services but were most pronounced on the surgical services.

Conclusion: Our study demonstrates that ID consultation for management of Staphylococcus aureus bacteremia is associated with more appropriate duration of treatment, evaluation by echocardiography and a lower rate of mortality at 30 days and 120 days.  Possible interventions could include mandatory ID consultation for SAB or standardized recommendations regarding management to be included with the SAB microbiology laboratory report.

Sarah Mansour, MBBCh, Infectious Disease, University of Alberta, Edmonton, AB, Canada, Arienne King, MD, PhD, Infectious Diseases, Grey Nuns Hospital, Edmonton, AB, Canada and Stephanie Smith, MD, MSc, FRCPC, Department of Medicine, Division of Infectious Diseases, University of Alberta, Edmonton, AB, Canada


S. Mansour, None

A. King, None

S. Smith, None

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