1085. Clinical Outcomes of Staphylococcus aureus Bacteremia Following Introduction of Mandatory Infectious Disease Specialist Consultation: A Retrospective 12-Month Study
Session: Poster Abstract Session: Clinical Infectious Diseases: Bacteremia and Endocarditis
Friday, October 28, 2016
Room: Poster Hall
Posters
  • ID Week Poster Presentation.pdf (1.3 MB)
  • Background: Staphylococcus aureus bacteremia (SAB) leads to high morbidity and mortality in hospital. We will investigate if mandatory infectious disease (ID) consultation as a hospital policy leads to improved clinical outcomes in patients with Staphylococcus aureus bacteremia (SAB).

    Methods: A pre- and post-intervention observational study compared process and outcome measures after a quality-improvement intervention. Pre-intervention population consisted of two subsets at 3 academic hospitals from 2007 to 2010: one group that received infectious disease consultation after positive S. aureus blood culture and the other group that did not. Intervention was implementation of mandatory ID consultation and SAB protocol for patients ≥18 years of age with ≥1 positive blood culture for S. aureus. Post-intervention population were patients with positive S. aureus culture between December 2014 and November 2015. Patients were excluded if within 2 days of blood culture they: died, were deemed palliative, or left against medical advice. Electronic medical records were assessed using a standardized data collection form.

    Results: In the pre-intervention population, 273/411 (66%) received ID consultations versus 144/411 (35%) who did not. In the post-intervention group, 216 patients with Staphylococcus aureus bacteremia were identified, of which 209 (96.8%) received ID consult. The pre-intervention group had an in-hospital mortality rate of 23% versus the cumulative in-hospital mortality among the 3 sites was 42/216 (19.4%). After the intervention, there was increased use of process measures, notably echocardiography. In the pre-intervention cohorts, 73% of IDC and 56% of NIDC received echocardiography versus the post-intervention group, in which 200/216 (92.6%) received echocardiography.

    Mortality by Site

     

    Pre-intervention

    Post-Intervention

    P-value

    Site 1

    33/121 (27%)

    6/46 (13%)

    0.0653

    Site 2

    28/117 (24%)

    15/68 (22%)

    0.8576

    Site 3

    33/173 (19%)

    21/102 (20.6%)

    0.7559

    Overall

    94/411 (23%)

    42/216 (19.4%)

    0.3593

    Conclusion: This study demonstrates that mandatory ID consultation for S. aureus bacteremia resulted in improved adherence to certain process measures; however, there are no significant improvements in mortality.

    Venus Valbuena, BScN, RN1, Anthony Bai, BHSc, MD2, Mahbuba Meem, BSc, MSc1, Adrienne Showler, MD3, Marilyn Steinberg, RN4, Chaim Bell, MD, PhD3 and Andrew Morris, MD, SM3, (1)Faculty of Medicine, University of Toronto, Toronto, ON, Canada, (2)University of Ottawa, Ottawa, ON, Canada, (3)University of Toronto, Toronto, ON, Canada, (4)Mount Sinai Hospital, Toronto, ON, Canada

    Disclosures:

    V. Valbuena, None

    A. Bai, None

    M. Meem, None

    A. Showler, None

    M. Steinberg, None

    C. Bell, None

    A. Morris, 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.