title: Impact of routine infectious diseases service consultation on the evaluation, management, and outcomes of Staphylococcus aureus bacteremia.
abstract: BACKGROUND
  Staphylococcus aureus bacteremia causes considerable morbidity and mortality, and strategies to improve management and outcomes of this disease are needed.
  
  
  METHODS
  Routine consultation with an infectious diseases specialist for cases of S. aureus bacteremia was mandated at our institution in May 2005. We compared the evaluation, management, and outcomes of cases before and after this policy change. All comparisons are by period (i.e., before or after initiation of the policy of routine consultation).
  
  
  RESULTS
  In the year before and the year after after the implementation of routine consultation, 134 and 100 cases of S. aureus bacteremia, respectively, were evaluated. Consultation rates increased from 53% of cases before to 90% of cases after the policy change (p < .001). Echocardiography (57% vs. 73%; p = .01) and radiographic studies (81% vs. 91%; p = .04) were used more frequently during the period of routine consultation, and infective endocarditis or metastatic infections were diagnosed more frequently (33% vs. 46%; p = .04). All 4 standards of care (removal of intravascular foci of infection, obtaining follow-up blood culture samples, use of parenteral beta-lactam therapy when possible, and administration of >/=28 days of therapy for complicated infections) were adhered to more frequently with routine consultation (40% vs. 74%; P <.001). Treatment failure (microbiological failure, recurrent bacteremia, late metastatic infection, or death) occurred less often during the intervention year (17% vs. 12%), but this difference was not statistically significant (p = .27).
  
  
  CONCLUSIONS
  A policy of routine consultation with an infectious diseases specialist for patients with S. aureus bacteremia resulted in more-detailed evaluation, more-frequent detection of endocarditis and metastatic infection, and improved adherence to standards of care.
authors.affiliation: Division of Infectious Diseases, Denver Health and Hospital Authority, Colorado, USA. timothy.jenkins@dhha.org
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Jenkins
authors.forename: Connie S
authors.initials: CS
authors.lastname: Price
authors.forename: Allison L
authors.initials: AL
authors.lastname: Sabel
authors.forename: Philip S
authors.initials: PS
authors.lastname: Mehler
authors.forename: William J
authors.initials: WJ
authors.lastname: Burman
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000150:complications / Q000188:drug therapy*; D004452:Echocardiography / Q000706:statistics & numerical data; D004696:Endocarditis / Q000175:diagnosis; D005260:Female; D019983:Guideline Adherence; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D016134:Organizational Policy; D011859:Radiography / Q000706:statistics & numerical data; D012017:Referral and Consultation; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy*; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D016896:Treatment Outcome