title: Telephone consultation cannot replace bedside infectious disease consultation in the management of Staphylococcus aureus Bacteremia.
abstract: BACKGROUND
  Infectious disease specialist (IDS) consultation improves the outcome of Staphylococcus aureus bacteremia (SAB). Although telephone consultations constitute a substantial part of IDS consultations, their impact on treatment outcome lacks evaluation.
  
  
  METHODS
  We retrospectively followed 342 SAB episodes with 90-day follow-up, excluding 5 methicillin-resistant S. aureus SAB cases. Patients were grouped according to bedside, telephone, or no IDS consultation within the first week. Patients with fatal outcome within 3 days after onset of SAB were excluded to allow for the possibility of death occurring before IDS consultation.
  
  
  RESULTS
  Seventy-two percent of patients received bedside, 18% telephone, and 10% no IDS consultation. Patients with bedside consultation were less often treated in an intensive care unit during the first 3 days compared to those with telephone consultation (odds ratio [OR], 0.53; 95% confidence interval [CI], .29-.97; P = .037; 21% vs 34%), with no other initial differences between these groups. Patients with bedside consultation more often had deep infection foci localized as compared to patients with telephone consultation (OR, 3.11; 95% CI, 1.74-5.57; P < .0001; 78% vs 53%). Patients with bedside consultation had lower mortality than patients with telephone consultation at 7 days (OR, 0.09; 95% CI, .02-.49; P = .001; 1% vs 8%), at 28 days (OR, 0.27; 95% CI, .11-.65; P = .002; 5% vs 16%) and at 90 days (OR, 0.25; 95% CI, .13-.51; P < .0001; 9% vs 29%). Considering all prognostic markers, 90-day mortality for telephone-consultation patients was higher (OR, 2.31; CI, 95% 1.22-4.38; P = .01) as compared to bedside consultation.
  
  
  CONCLUSIONS
  Telephone IDS consultation is inferior to bedside IDS consultation.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland. erik.forsblom@helsinki.fi
authors.forename: E
authors.initials: E
authors.lastname: Forsblom
authors.forename: E
authors.initials: E
authors.lastname: Ruotsalainen
authors.forename: J
authors.initials: J
authors.lastname: Ollgren
authors.forename: A
authors.initials: A
authors.lastname: Järvinen
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000401:mortality; D003141:Communicable Diseases / Q000628:therapy; D019468:Disease Management; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D012017:Referral and Consultation / Q000592:standards*; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000401:mortality; D013211:Staphylococcus aureus; D013689:Telephone / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents