Research Articles from the SHS-UHN ASP (Category)

Positive Impact of Infectious Disease Consultation on Quality of Care, Mortality and Length of Stay in Staphylococcus aureus Bacteremia: Results from a Large Multicenter Cohort Study

AD Bai
A Showler
L Burry
M Steinberg
D Ricciuto
T Fernandes
A Chiu
S Raybardhan
M Science
E Fernando
GA Tomlinson
CM Bell
AM Morris



BACKGROUND:  We assessed the impact of Infectious Disease (ID) consultation on management and outcome in Staphylococcus aureus bacteremia (SAB).

METHODS:  A retrospective cohort study examined consecutive SAB patients from six academic and community hospitals between 2007 and 2010.  Quality measures of management, including echocardiogram, repeat blood culture, removal of infectious foci, and antibiotic therapy were compared between ID consultation (IDC) and no ID consultation (NIDC) groups.  A competing risk model with propensity score adjustment was used to compare in-hospital mortality and time to discharge.

RESULTS:  Of 847 SAB patients, 506 (60%) patients received an ID consultation and 341 (40%) patients did not.  During hospital stay, 371 (73%) IDC patients and 191 (56%) NIDC patients received an echocardiogram (p<0.0001).  Repeat blood cultures in 2-4 days of bacteremia were performed in 207 (41%) IDC patients and 107 (31%) NIDC patients (p=0.0058).  There was no statistical difference in removal of infectious foci between the two groups.  For patients who were alive when the antibiotic course was completed, 285/422 (68%) IDC patients and 141/262 (54%) NIDC patients received the appropriate duration of antibiotic therapy (p=0.0004).

During hospital stay, 204 (24%) patients died: 104 (21%) IDC patients and 100 (29%) NIDC patients.  Matched by propensity score, ID consultation had a sub-distribution hazard ratio (sHR) of 0.72 (95% CI:0.52-0.99, p=0.0451) for in-hospital mortality and 1.28 (95% CI:1.06-1.56, p=0.0109) for being discharged alive.

CONCLUSIONS:  ID consultation is associated with adherence to quality measures, reduced in-hospital mortality and earlier discharge in SAB patients.