1086. Impact of an Infectious Diseases Consult on Staphylococcus aureus Bacteremia Management
Session: Poster Abstract Session: Clinical Infectious Diseases: Bacteremia and Endocarditis
Friday, October 28, 2016
Room: Poster Hall
Posters
  • Cole_ID_Consult_SAB_Management_IDWEEK_2016.pdf (454.1 kB)
  • Background: Consultation by an infectious diseases (ID) specialist has been demonstrated to reduce in-hospital mortality and improve adherence to recommended clinical practice guidelines in the standard of care of Staphylococcus aureus bacteremia (SAB). We aimed to evaluate the impact of laboratory initiated ID consult on the management of SAB after implementation by our antimicrobial stewardship program (ASP).

    Methods: IRB-approved, retrospective cohort including all patients treated for their first documented SAB at the University of Toledo Medical Center between January 1, 2010 and July 31, 2015. Patients who expired within two days of positive blood culture, had a polymicrobial bloodstream infection, or were admitted to hospice/palliative care during treatment were excluded. Outcomes were compared between ID- and no-ID consult groups. Primary endpoint of overall adherence to an ID bundle: follow-up blood cultures within 96 hours of initial positive, record of echocardiogram, identification and control of infectious foci, and appropriate duration and selection of antibiotics. Secondary endpoints: adherence to individual bundle elements, and 30-day readmission and 30-day all-cause mortality.

    Results: 256 positive blood cultures screened, 162 included: 131 ID consult, 31 no-ID consult; median (IQR) age 58 (45-66) years, 55.6% male. Overall bundle adherence for ID consult vs. no-ID consult was 42% vs. 6.5% (p<0.001). Significant differences seen in all individual bundle elements as well (Table 1). 30-day all-cause mortality (4% vs. 17%, p = 0.62) and 30-day readmission (7% vs. 32%, p = 0.058) were not significantly different.

    Table 1. Individual Bundle Element Adherence

    ID-Consult
    (n = 131)

    No-ID-Consult
    (n = 31)

    p

    Repeat blood cultures

    117 (89)

    15 (48)

    < 0.001

    Echocardiogram

    122 (93)

    22 (71)

    0.002

    Source control

    87 (66)

    10 (32)

    <0.001

    Appropriate antibiotics

    120 (92)

    22 (71)

    0.004

    Appropriate duration

    109 (83)

    14 (45)

    <0.001

    Values reported as n (%)

    Conclusion: Addition of an ID consult significantly improved adherence to the clinical and diagnostic tools that are recommended as standard of care for SAB. These findings support the addition of a lab-driven protocol of automatic ID consultation for SAB as a key ASP intervention at our institution.

    John Edelstein, PharmD, Jessica Pakulski, PharmD, BCPS, Lindsey Eitniear, PharmD, William Helmink, MBA, MT (ASCP), Claudiu Georgescu, MD and Kelli Cole, PharmD, BCPS, University of Toledo Medical Center, Toledo, OH

    Disclosures:

    J. Edelstein, None

    J. Pakulski, None

    L. Eitniear, None

    W. Helmink, None

    C. Georgescu, None

    K. Cole, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.