Clin Microbiol Infect. 2023 Mar 11:S1198-743X(23)00123-4. doi: 10.1016/j.cmi.2023.03.009. Online ahead of print.
OBJECTIVES: Infectious disease consultation (IDC) has been associated with improved outcomes in several infections, but the benefit of IDC among patients with enterococcal bacteremia has not been fully evaluated.
METHODS: We performed a 1:1 propensity-score matched retrospective cohort study evaluating all patients with enterococcal bacteremia at 121 Veterans Health Administration acute-care hospitals from 2011 to 2020. The primary outcome was 30-day mortality. We performed conditional logistic regression to calculate the odds ratio (OR) to determine the independent association of IDC and 30-day mortality adjusted for vancomycin susceptibility and the primary source of bacteremia.
RESULTS: 12,666 patients with enterococcal bacteremia were included. 8,400 (63.3%) had IDC and 4,266 (36.7%) did not have IDC. 2,972 patients in each group were included after propensity-score matching. Conditional logistic regression revealed that IDC was associated with a significantly lower 30-day mortality rate compared to patients without IDC (OR=0.56; 95% CI, 0.50-0.64). The association of IDC was observed irrespective of vancomycin susceptibility, and when the primary source of bacteremia was a urinary tract infection, or from an unknown primary source. IDC was also associated with higher appropriate antibiotic use, blood culture clearance documentation, and the use of echocardiography.
CONCLUSIONS: Our study suggests that IDC was associated with improved care processes and 30-day mortality rates among patients with enterococcal bacteremia. IDC should be considered for patients with enterococcal bacteremia.
PMID:36914070 | DOI:10.1016/j.cmi.2023.03.009