Methods: A retrospective, quasi-experimental design was used. All positive blood cultures at two academic medical centers from March 2013 to October 2014 (12 months prior to and 6 months after implementation of MALDI) were identified and narrowed to 3,192 unique episodes of which 1,000 charts were reviewed. Interrupted time series analysis compared ID consult rates to a renal consult control group. Secondary analyses explored differences in patients who received consults versus those who did not.
Results: ID consult patients were more likely than non-consults to be younger (59 vs 64y, p<0.001), male (60 vs 44%, p<0.001), and white (34 vs 23%, p<0.001). Most consults were for a positive blood culture (71%); but surgical services consulted at nearly double the rate of medical services (65 vs 38%, p<0.001). Polymicrobial bacteremia elicited a higher rate than monomicrobial (21 vs 11%, p<0.001). Length of stay was longer in patients receiving ID consults (20.4 vs 8.5 days, p<0.001); however, mortality did not differ significantly between the two groups (11.2 vs 12.4%, p=0.540). Consults more often had primary bacteremia (40.6 vs 14.5%, p<0.000), osteomyelitis (6.2 vs 1.7%, p<0.001), or endocarditis (6.2 vs 0.2%, p<0.001), whereas non-consults were more likely to be deemed a contaminant (37.3 vs 12.1%, p=0.003) or have a urinary (17.8 vs 6.4%, p=0.024) or GI source (8.9 vs 6.7%, p=0.008). There were no significant differences between patients evaluated in the pre- and post-intervention groups. Interrupted time series analysis revealed no significant difference in trends in ID consult rate after the implementation of MALDI-TOF (p=0.268) and no difference compared to the control group (p=0.968).
Conclusion: The rate of ID consults (versus control) did not change after the implementation of MALDI-TOF; however, differences between patients with and without ID consults warrant further exploration.
T. Barton, None
V. Cluzet, None