1220. Impact of Mandatory Infectious Diseases Consultation on the Use of Core Measures and Mortality in Staphylococcus aureus Bacteremia (SAB) at an Academic Medical Center
Session: Poster Abstract Session: Healthcare Epidemiology: MSSA, MRSA and Other Gram Positive Infections
Friday, October 5, 2018
Room: S Poster Hall
Background: Multiple studies have shown that Infectious Diseases (ID) consultation significantly improves adherence to guidelines for patients with SAB and decreases mortality. Data from a prior retrospective study done at Hahnemann University Hospital showed that ID consultation improved the use of guideline-based core measures for SAB management. Based on this data, a mandatory ID consultation was established at our institution in November 2016.

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.

Elizabeth Gancher, MD1, Gregory Maslak, MD2, Jonathan Lustgarten, MS, PhD, VMD3, Sara Schultz, MD1 and Marinela Ingilizova, MD1, (1)Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA, (2)Department of Medicine, Drexel College of Medicine, Philadelphia, PA, (3)Compassion-First Pet Hospitals, Tinton Falls, NJ


E. Gancher, None

G. Maslak, None

J. Lustgarten, None

S. Schultz, None

M. Ingilizova, None

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