Impact of infectious diseases consultation on clinical outcomes of patients with Staphylococcus aureus bacteremia at a community health system.
Antimicrob Agents Chemother. 2016 Jul 11;
Authors: Turner RB, Valcarlos E, Won R, Chang E, Schwartz J
BACKGROUND: Staphylococcus aureus bacteremia (SAB) causes high rates of morbidity and mortality. Several studies in academic health settings have demonstrated that consultation from infectious diseases specialists improves quality of care and clinical outcomes for SAB. Little data are available describing this impact in resource-limited settings such as community hospitals.
METHODS: This retrospective cohort study evaluated adherence to quality of care indicators and clinical outcomes for SAB at a 5-hospital community health-system (range of 95 to 272 available beds per hospital) in patients with and without infectious diseases consultation (IDC). IDC was provided if requested by the attending physician. The primary outcome was incidence of treatment failure defined as 30-day in-hospital mortality or 90-day SAB recurrence. Other outcomes included adherence to quality of care indicators.
RESULTS: Four hundred and seventy three adult patients with SAB were included with 369 (78%) receiving IDC. We identified substantial differences in baseline characteristics between IDC and no-IDC groups including greater incidence of complicated bacteremia and intravenous drug users in the IDC group with similar rates of severity of illness as measured by the Pitt bacteremia score. Adherence to quality of care indicators was higher in those with IDC (P < 0.001). After adjusting for other predicting variables, IDC was associated with lower treatment failure (adjusted OR 0.42 95% CI 0.20 to 0.86, P = 0.018).
CONCLUSIONS: IDC provided greater quality of care and better clinical outcomes for patients with SAB who were treated at small, resource-limited community hospitals.
PMID: 27401580 [PubMed - as supplied by publisher]