Mandatory infectious diseases consultation for MRSA bacteremia is associated with reduced mortality.
OBJECTIVE
Although infectious disease (ID) consultation has been associated with lower mortality in Staphylococcus aureus bloodstream infections, it is still not mandatory in many centers. This study aimed at assessing the impact of ID consultation on diagnostic and therapeutic management of methicillin-resistant S. aureus (MRSA) bacteremia.


METHODS
Retrospective cohort study of all patients with MRSA bacteremia from 2001 to 2010. ID consultations were obtained on request between 2001 and 2006 and became mandatory since 2007.


RESULTS
156 episodes of MRSA bacteremia were included, mostly from central venous catheter (32%) and skin and soft tissue (19%) infections. ID consultation coverage was 58% between 2001 and 2006 and 91% between 2007 and 2010. ID consultation was associated with more echocardiography (59% vs. 26%, p < 0.01), vancomycin trough level measurements (99% vs. 77%, p < 0.01), follow-up blood cultures (71% vs. 50%, p = 0.05), deep-seated infections (43% vs. 16%, p < 0.01), more frequent infection source control (83% vs. 57%, p = 0.03), a longer duration of MRSA-active therapy (median and IQR: 17 days, 13-30, vs. 12, 3-14, p < 0.01) and a 20% reduction in 7-day, 30-day and in-hospital mortality.


CONCLUSIONS
ID consultation was associated with a better management of patients with MRSA bacteremia and a reduced mortality.
Infectious Diseases Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland. Electronic address: frederic.tissot@chuv.ch.
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Tissot
Infectious Diseases Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland.
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Calandra
Institute of Microbiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland.
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Prod'hom
Institute for Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland.
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Taffe
Infectious Diseases Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Service of Hospital Preventive Medicine, Department of Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland.
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Zanetti
Infectious Diseases Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Institute of Microbiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland.
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Greub
Infectious Diseases Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Service of Hospital Preventive Medicine, Department of Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland.
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Senn
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000097:blood; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D001769:Blood / Q000382:microbiology; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D004452:Echocardiography; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D055552:Infectious Disease Medicine; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D016134:Organizational Policy; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000639:trends; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D013207:Staphylococcal Skin Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D014640:Vancomycin / Q000008:administration & dosage / Q000097:blood
D000900:Anti-Bacterial Agents; D014640:Vancomycin
Bloodstream infection; Infectious diseases consultation; MRSA; Outcome