title: Formal infectious diseases consultation is associated with decreased mortality in Staphylococcus aureus bacteraemia.
abstract: To determine the impact of infectious diseases consultation (IDC) in Staphylococcus aureus bacteraemia. All MRSA bacteraemia and a random subset of MSSA bacteraemia were retrospectively analysed. Out of 599 SAB episodes, 162 (27%) were followed by an IDC. Patients with IDC were younger and more frequently intravenous drug users, but fewer resided in a long-term care facility or were indigenous. Hospital length of stay was longer (29.5 vs 17 days, p < 0.001), and endocarditis (19.1% vs 7.3%, p < 0.001) and metastatic seeding (22.2% vs 10.1%, p < 0.001) were more frequent in the IDC group; however, SAPS II scores were lower in the IDC group (27 vs 37, p < 0.001). ICU admission rates in the two groups were similar. The isolate tested susceptible to empirical therapy more frequently in the IDC group (88.9% vs 78.0%, p = 0.003). Seven-day (3.1 vs 16.5%), 30-day (8.0% vs 27.0%) and 1-year mortality (22.2% vs 44.9%) were all lower in the IDC group (all p < 0.001). Multivariate analysis showed that effective initial therapy was the only variable associated with the protective effect of IDC. In patients with SAB, all-cause mortality was significantly lower in patients who had an IDC, because of the higher proportion of patients receiving effective initial antibiotics.
authors.affiliation: Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine Royal Perth Hospital, Wellington Street, Perth, 6000, Western Australia, Australia. owen.robinson@health.wa.gov.au.
authors.forename: J O
authors.initials: JO
authors.lastname: Robinson
authors.forename: S
authors.initials: S
authors.lastname: Pozzi-Langhi
authors.forename: M
authors.initials: M
authors.lastname: Phillips
authors.forename: J C
authors.initials: JC
authors.lastname: Pearson
authors.forename: K J
authors.initials: KJ
authors.lastname: Christiansen
authors.forename: G W
authors.initials: GW
authors.lastname: Coombs
authors.forename: R J
authors.initials: RJ
authors.lastname: Murray
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*; D002648:Child; D003422:Critical Care / Q000706:statistics & numerical data; D004697:Endocarditis, Bacterial / Q000453:epidemiology; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents