title: Impact of Infectious Disease Consultation on Quality of Care, Mortality, and Length of Stay in Staphylococcus aureus Bacteremia: Results From a Large Multicenter Cohort Study.
abstract: BACKGROUND
  We assessed the impact of infectious disease (ID) consultation on management and outcome in patients with Staphylococcus aureus bacteremia (SAB).
  
  
  METHODS
  A retrospective cohort study examined consecutive SAB patients from 6 academic and community hospitals between 2007 and 2010. Quality measures of management including echocardiography, repeat blood culture, removal of infectious foci, and antibiotic therapy were compared between ID consultation (IDC) and no ID consultation (NIDC) groups. A competing risk model with propensity score adjustment was used to compare in-hospital mortality and time to discharge.
  
  
  RESULTS
  Of 847 SAB patients, 506 (60%) patients received an ID consultation and 341 (40%) patients did not. Echocardiography was done for 371 (73%) IDC and 191 (56%) NIDC patients (P < .0001) in hospital. Blood cultures were repeated within 2-4 days of bacteremia in 207 (41%) IDC and 107 (31%) NIDC patients (P = .0058). The infectious foci removal rate was not statistically different between the 2 groups. For empiric therapy, 474 (94%) IDC and 297 (87%) NIDC patients received appropriate antibiotics (P = .0013). For patients who finished the planned course of antibiotics, 285 of 422 (68%) IDC and 141 of 262 (54%) NIDC patients received the appropriate duration of antibiotic therapy (P = .0004). In hospital, 204 (24%) patients died: 104 of 506 (21%) IDC and 100 of 341 (29%) NIDC patients. Matched by propensity score, ID consultation had a subdistribution hazard ratio of 0.72 (95% confidence interval [CI], .52-.99; P = .0451) for in-hospital mortality and 1.28 (95% CI, 1.06-1.56; P = .0109) for being discharged alive.
  
  
  CONCLUSIONS
  ID consultation is associated with better adherence to quality measures, reduced in-hospital mortality, and earlier discharge in patients with SAB.
authors.affiliation: Faculty of Medicine, University of Ottawa.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Bai
authors.affiliation: Department of Medicine, University of Toronto.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Showler
authors.affiliation: Mount Sinai Hospital, Toronto Leslie Dan Faculty of Pharmacy, University of Toronto.
authors.forename: Lisa
authors.initials: L
authors.lastname: Burry
authors.affiliation: Mount Sinai Hospital, Toronto.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Steinberg
authors.affiliation: Department of Medicine, University of Toronto Lakeridge Health, Oshawa.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Ricciuto
authors.affiliation: Trillium Health Partners, Mississauga.
authors.forename: Tania
authors.initials: T
authors.lastname: Fernandes
authors.affiliation: Trillium Health Partners, Mississauga.
authors.forename: Anna
authors.initials: A
authors.lastname: Chiu
authors.affiliation: North York General Hospital.
authors.forename: Sumit
authors.initials: S
authors.lastname: Raybardhan
authors.affiliation: Hospital for Sick Children.
authors.forename: Michelle
authors.initials: M
authors.lastname: Science
authors.affiliation: Department of Medicine, University of Toronto.
authors.forename: Eshan
authors.initials: E
authors.lastname: Fernando
authors.affiliation: Department of Medicine, University of Toronto University Health Network.
authors.forename: George
authors.initials: G
authors.lastname: Tomlinson
authors.affiliation: Department of Medicine, University of Toronto Mount Sinai Hospital, Toronto Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Chaim M
authors.initials: CM
authors.lastname: Bell
authors.affiliation: Department of Medicine, University of Toronto Mount Sinai Hospital, Toronto University Health Network.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Morris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000401:mortality*; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Staphylococcus aureus; bacteremia; infectious disease consultation; mortality; quality of care