Methods: A retrospective, observational study was conducted to evaluate patient characteristics, adherence to core measures for SAB, and in-hospital mortality. All patients with at least one documented blood culture positive for S. aureus were stratified into two groups: pre-mandatory consult (January 1, 2014 - November 1, 2016) and post mandatory consult (November 2, 2016 - February 1, 2018).
Results: 373 discrete episodes of SAB were included in the final analysis, 238 episodes before mandatory consult and 135 episodes after the mandatory consult policy was enacted. Mandatory consultation significantly improved the use of the following core measures for SAB: surveillance blood cultures (87.7% pre vs 99.2% post, p < 0.001), echocardiography (81.9% vs 96.9%, p < 0.001), early targeted antimicrobial therapy with nafcillin or cefazolin in MSSA (71.7% vs 88.6%, p < 0.001), and appropriateness of final antibiotic choice (80.2% vs 95.2%, p < 0.001). In addition, in-hospital mortality (15.4% vs 6.2%, p = 0.011), and infection-related mortality (14.3% vs 5.6%, p = 0.011) were found to be statistically significantly lower in the post mandatory consultation patients.
Conclusion: Implementation of a mandatory ID consultation for patients with SAB at our institution was associated with increased adherence to guideline-based core measures for management of SAB, and decreased in-hospital and infection-related mortality. Our results suggest that mandatory ID consultation for SAB should be considered at all institutions.
J. Lustgarten, None
S. Schultz, None
M. Ingilizova, None
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