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ID Consults Linked to Better Long-Term Outcomes for S aureus Bacteremia

FEB 18, 2020 | GRANT M. GALLAGHER
Staphylococcus aureus infections are a substantial burden on patients and health, particularly when they lead to bacteremia. Past attempts to develop a vaccine for S aureus have been repeatedly thwarted, and questions remain about proposals for improving treatment.

According to the investigators of a new study, published in JAMA Network Open, there is one relatively simple way to improve long-term patient discharges outcomes. The study team found that having an infectious disease consultation during hospital stays was associated with improved postdischarge outcomes for at least 5 years.

The investigators conducted a cohort study including 31,002 patients with a first episode of S aureus bacteremia who were discharged from 116 acute care units of the Veterans Health Administration across the United States where infectious disease consultation was offered.

Data were collected between January 2003 and December 2014, with follow-up through September 2018.

The primary outcome of the study was time to development of a composite event of all-cause mortality or recurrence of S aureus bacteremia within 5 years after discharge.

Of the 31,002 patients, 97.6% were men. The median age at onset of S aureus bacteremia was 64 years old.

Among the total patient population, there were 18,794 deaths, representing 60.6% of the study population. There were 4772 (15.4%) S aureus cases of bacteremia recurrence and 20,414 composite events during the 5 years of follow-up.

A majority of patient deaths (68%) and nearly half of recurrences (47.5%) occurred more than 90 days after discharge from the hospital.

Out of the total 31,002 patients, 15,360 (49.5%) received infectious disease consultation during the index hospital stay.

Infectious disease consultation was associated with lasting improvement in composite outcome (adjusted hazard ratio at 5 years, 0.71; 95% confidence interval, 0.68-0.74; P <  .001).

Patients who received an infectious disease consult also saw improved outcomes when all-cause mortality without recurrence and S aureus bacteremia recurrence were analyzed separately.

“Having an ID consultation during the index hospital stay among patients with [S aureus bacteremia] was associated with improved postdischarge outcomes for at least 5 years, suggesting that contributions of ID specialists to management during acute infection may have a substantial influence on long-term outcomes,” study authors wrote.

Various benefits have been associated with infectious disease consultation in the past.

Research from the Washington University School of Medicine in St. Louis, for example, found that when an infectious disease physician oversaw care of a patient with candidemia, the mortality rate declined by 20%.

Even in conditions when patient outcomes are minimally impacted, the presence of an infectious disease consultant can also lead to superior antibiotic stewardship.

While a Jefferson Health New Jersey study was able to find only 1 of 3 hospitals with a requirement for infectious disease consultation exhibiting a statistically significant decrease in hospital-acquired Clostridioides difficile infection rate, the mandatory infectious disease consultations did lead to a decrease in days of therapy per 1000 patient-days due to more appropriate antibiotic use.

Other studies have shown that early infectious disease consultation within 12 hours of hospital admission reduces sepsis-related mortality by as much as 40%.

Clearly, hospitals and patients have much to gain from taking infectious disease consultation seriously as an integral component of proper patient care.
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