1062. Staphylococcus aureus bacteremia: the impact of infectious diseases consultation at a large urban hospital
Session: Poster Abstract Session: Clinical Infectious Diseases: Bacteremia and Endocarditis
Friday, October 28, 2016
Room: Poster Hall
Posters
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  • Background: Infectious diseases (ID) consultation for Staphylococcus aureus bacteremia (SAB) has been shown to reduce mortality, prompting some healthcare centers to institute a mandatory ID consult for these patients. NYPH does not currently have this policy. Here we describe the utility of ID consultation in a retrospective series of SAB patients at NYPH. We compare clinial management and outcomes of SAB patients who received ID consultation with those who did not.

    Methods: We reviewed all adult inpatients at NYPH with blood cultures positive for S. aureus from 7/25/14 to 12/28/14. For patients with multiple episodes of SAB within the study period, only the first episode was included. Inpatient and outpatient medical records were reviewed. Data were entered into a de-identified database. Statistical analysis was performed using IBM SPSS v20. Paired t-tests were used for continuous variables and Chi-square tests for categorical variables.

    Results: Sixty-four episodes of S. aureus bacteremia were identified. Six were excluded because of age below 18, outpatient status, or recurrent bacteremia. Of the 58 remaining patients, 41 (71%) had an ID consult. 43/58 (74%) were on a medicine service, and 32 of these patients (74%) had an ID consult. MRSA bacteremia occurred in 22 patients and 19/22 (86%) had an ID consult; MSSA bacteremia occurred in 36 patients and 22/36 (61%) had an ID consult (p = 0.04). Echocardiograms were performed in 38/41 (93%) of the ID consult group vs 8/17 (41%) in the no-consult group (p<0.001). In-hospital mortality rate was 17% (7/41) in the ID consult group vs 41% (7/17) in the no-consult group (p=0.051). Of the 17 patients who did not receive a consult, one had a primary ID hospitalist attending and five received end-of-life palliative care measures; four of the latter group died in the hospital. In two patients who did not receive an ID consult, the primary team was not aware of the culture results.

    Conclusion: Greater than two-thirds of inpatients with SAB had an ID consult, which is consistent with published data. ID consult was significantly associated with use of echocardiography. There was a trend toward lower mortality which may have been influenced by palliative care measures in the no-consult group. Targeted education toward primary services regarding the value of ID consultation in S. aureus bacteremia may improve patient outcomes.

    Charles Kyriakos Vorkas, MD, Shashi Kapadia, MD, Thomas Baker, MD, Kristen M. Marks, MD and Ole Vielemeyer, MD, Division of Infectious Diseases, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY

    Disclosures:

    C. K. Vorkas, None

    S. Kapadia, None

    T. Baker, None

    K. M. Marks, None

    O. Vielemeyer, 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.