title: Close cooperation between infectious disease physicians and attending physicians can result in better management and outcome for patients with Staphylococcus aureus bacteraemia.
abstract: Staphylococcus aureus bacteraemia (SAB) is a serious infection that demands prompt clinical attention for good outcome. To assess the impact of intervention by infectious diseases physicians (IDPs) in cases with SAB, a retrospective cohort study of patients with SAB was performed in a 1240-bed, university hospital in Japan, with the aim of comparing the management and outcome of patients during the initial and the latter half of the intervention period,. Three hundred and forty-six patients with SAB during the 7-year period, from 2002 to 2008, were included, and 194 patients in the initial half of the period (from 2002 to 2005) were compared with 152 patients in the later period (from 2006 to 2008). There was no significant difference between the two groups with respect to patient's clinical background, although more patients in the later period were receiving immunosuppressive treatment. The proportion of methicillin resistant S. aureus was lower during the later period (56.2% vs. 43.3%; p 0.02). Echocardiography was used more frequently (37.1% vs. 64.5%; p < 0.001). Infective endocarditis and metastatic infections were diagnosed more frequently (10.8% vs. 20.4%; p 0.01). Follow-up blood cultures were obtained more regularly (52.1% vs. 73.7%; p <0.001) and therapy was more frequently administered for at least 14 days (47.4% vs. 82.2%; p <0.001). The 30-day mortality improved during the intervention period (25.8% vs. 16.4%; p 0.04). The total number of blood cultures received by the laboratory increased annually and the total number of consultations increased by approximately 1.6-fold compared to 2002. Proactive intervention by IDPs raised awareness of optimal management of bacteraemia and improved the adherence to the standards of care, which subsequently resulted in an improvement in the outcome.
authors.affiliation: Department of Infection Control and Prevention, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, Japan. mnagao@kuhp.kyoto-u.ac.jp
authors.forename: M
authors.initials: M
authors.lastname: Nagao
authors.forename: Y
authors.initials: Y
authors.lastname: Iinuma
authors.forename: T
authors.initials: T
authors.lastname: Saito
authors.forename: Y
authors.initials: Y
authors.lastname: Matsumura
authors.forename: M
authors.initials: M
authors.lastname: Shirano
authors.forename: A
authors.initials: A
authors.lastname: Matsushima
authors.forename: S
authors.initials: S
authors.lastname: Takakura
authors.forename: Y
authors.initials: Y
authors.lastname: Ito
authors.forename: S
authors.initials: S
authors.lastname: Ichiyama
mesh_terms: D016470:Bacteremia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D019468:Disease Management; D006302:Health Services Research; D006801:Humans; D055552:Infectious Disease Medicine; D007564:Japan; D008505:Medical Staff, Hospital; D058007:Physicians, Primary Care; D012017:Referral and Consultation; D012189:Retrospective Studies; D059039:Standard of Care; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D013211:Staphylococcus aureus; D016896:Treatment Outcome