Int J Antimicrob Agents. 2022 Aug 26:106665. doi: 10.1016/j.ijantimicag.2022.106665. Online ahead of print.
ABSTRACT
It is unknown whether infectious diseases consultation improves outcomes for enterococcal bacteremia in a multicenter healthcare system. This retrospective multicenter observational cohort study included 250 adult patients with enterococcal bacteremia between July 2016 and December 2020. The primary endpoint was a composite of clinical failure, including persistent bacteremia, persistent fever, and in-hospital mortality. Secondary endpoints included adherence to a treatment bundle (appropriate empiric and definitive antibiotics, appropriate planned treatment duration, obtaining repeat blood cultures and an echocardiogram). Clinical failure occurred in 22.6% (35/155) of patients with an infectious diseases consultation and in 16.8% (16/95) of patients without an infectious diseases consultation (p = 0.274). Multivariate analysis identified vasopressors as the only independent predictor of the primary outcome. Infectious diseases consultation resulted in higher adherence to a treatment bundle, including echocardiogram (75.5% vs 34.7%, p < 0.0001), repeat blood cultures (85.2% vs 68.4%, p = 0.002), appropriate definitive antibiotics (70.5% vs 91.6%, p < 0.0001) and appropriate planned durations of therapy (81.1% vs 94.2%, p = 0.001). More patients in the consult group were treated with ampicillin (47.1% vs 22.1%, p < 0.0001) and less were treated with vancomycin (17.4% vs 24.2%, p = 0.068). Despite finding no difference in clinical failure between groups, our study highlights important benefits of infectious diseases consultation in enterococcal bacteremia.
PMID:36038096 | DOI:10.1016/j.ijantimicag.2022.106665