title: Infectious diseases consultation lowers mortality from Staphylococcus aureus bacteremia.
abstract: Staphylococcus aureus bacteremia (SAB) is a lethal and increasingly common infection in hospitalized patients. We assessed the impact of infectious diseases consultation (IDC) on clinical management and hospital mortality of SAB in 240 hospitalized patients in a retrospective cohort study. Patients who received IDC were older than those who did not (57.9 vs. 51.7 yr; p = 0.05), and were more likely to have a health care-associated infection (63% vs. 45%; p < 0.01). In patients who received IDC, there was a higher prevalence of severe complications of SAB such as central nervous system involvement (5% vs. 0%, p = 0.01), endocarditis (20% vs. 2%; p < 0.01), or osteomyelitis (15.6% vs. 3.4%; p < 0.01). Patients who received IDC had closer blood culture follow-up and better antibiotic selection, and were more likely to have pus or prosthetic material removed. Hospital mortality from SAB was lower in patients who received IDC than in those who did not (13.9% vs. 23.7%; p = 0.05). In multivariate survival analysis, IDC was associated with substantially lower hazard of hospital mortality during SAB (hazard 0.46; p = 0.03). This mortality benefit accrued predominantly in patients with methicillin-resistant SAB (hazard 0.3; p < 0.01), and in patients who did not require ICU admission (hazard 0.15; p = 0.01). In conclusion, IDC is associated with reduced mortality in patients with staphylococcal bacteremia.
authors.affiliation: From Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Timothy
authors.initials: T
authors.lastname: Lahey
authors.forename: Ruta
authors.initials: R
authors.lastname: Shah
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gittzus
authors.forename: Joseph
authors.initials: J
authors.lastname: Schwartzman
authors.forename: Kathryn
authors.initials: K
authors.lastname: Kirkland
mesh_terms: D016470:Bacteremia / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control; D002493:Central Nervous System Diseases / Q000382:microbiology / Q000401:mortality; D004696:Endocarditis / Q000382:microbiology / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007861:Lebanon / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000382:microbiology / Q000401:mortality; D015995:Prevalence; D012017:Referral and Consultation; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D016019:Survival Analysis