Reduced Mortality after Hospital-Wide Initiative to Facilitate Infectious Diseases Consultation for Staphylococcus aureus Bacteremia

Background:

Infectious diseases consultation (IDC) in patients with Staphylococcus aureusbacteremia (SAB) has been associated with lower mortality. Our aim was to implement formal IDC for all patients with SAB and compare the adherence to quality metrics before and after the intervention.

Methods:

In the intervention phase, a daily report of SAB was reviewed and IDC was facilitated for patients without IDC. In the pre- and post-intervention phases, data was collected prospectively. Exclusion criteria were autopsy specimens, death prior to identification of SAB, hospice patients, and discharge against medical advice. The primary outcome was IDC within one day of reported SAB. Secondary outcomes were follow up blood cultures within 72 hours, removal of nonpermanent vascular catheter or abscess drainage within 72 hours, switch to beta-lactam within 24 hours of confirming methicillin-susceptibility, intravenous therapy for ≥2 weeks, time from identification of SAB to IDC, and 3-month mortality.

Results:

After exclusion criteria, there were 76 episodes of SAB in the pre-intervention period (3/12/15-7/14/15), and 165 SAB episodes in the intervention period (7/15/15-2/29/16). In the pre-intervention phase, IDC was not performed in three episodes and was delayed >1 day in nine (12%). During the intervention period, IDC was facilitated in 29 (18%) episodes, and IDC was performed within one day in all but one patient. There was improvement in obtaining follow-up blood cultures and statistically significant improvements in appropriate antibiotic duration and mortality during the intervention phase (Table 1).

Conclusion:

A hospital-wide initiative to facilitate IDC for all patients with SAB resulted in nearly universal IDC within one day, improvement in adherence to quality indicators (appropriate antibiotic duration and follow-up blood cultures), and lower 3-month mortality.