title: Impact of routine bedside infectious disease consultation on clinical management and outcome of Staphylococcus aureus bacteraemia in adults.
abstract: Staphylococcus aureus bacteraemia (SAB) is a common, serious infection that is associated with high rates of morbidity and mortality. Evidence suggests that infectious disease consultation (IDC) improves clinical management in patients with SAB. We examined whether the introduction of a routine bedside IDC service for adults with SAB improved clinical management and outcomes compared to telephone consultation. We conducted an observational cohort study of 571 adults with SAB at a teaching hospital in the United Kingdom between July 2006 and December 2012. A telephone consultation was provided on the day of positive blood culture in all cases, but an additional bedside IDC was provided after November 2009 (routine IDC group). Compared to patients in the pre-IDC group, those in the routine IDC group were more likely to have a removable focus of infection identified, echocardiography performed and follow-up blood cultures performed. They also received longer courses of antimicrobial therapy, were more likely to receive combination antimicrobial therapy and were more likely to have SAB recorded in the hospital discharge summary. There was a trend towards lower mortality at 30 days in the routine IDC group compared to the pre-IDC group (12% vs. 22%, p 0.07). Our findings suggest that routine bedside IDC should become the standard of care for adults with SAB.
authors.affiliation: Department of Dermatology, Royal North Shore Hospital, St Leonards, Australia.
authors.forename: R B
authors.initials: RB
authors.lastname: Saunderson
authors.affiliation: Department of Medicine, University of Cambridge, UK; Clinical Microbiology and Public Health Laboratory, Public Health England, UK; Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: T
authors.initials: T
authors.lastname: Gouliouris
authors.affiliation: Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: E K
authors.initials: EK
authors.lastname: Nickerson
authors.affiliation: Department of Medicine, University of Cambridge, UK.
authors.forename: E J P
authors.initials: EJ
authors.lastname: Cartwright
authors.affiliation: Department of Medicine, University of Cambridge, UK.
authors.forename: A
authors.initials: A
authors.lastname: Kidney
authors.affiliation: Clinical Microbiology and Public Health Laboratory, Public Health England, UK; Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: S H
authors.initials: SH
authors.lastname: Aliyu
authors.affiliation: Clinical Microbiology and Public Health Laboratory, Public Health England, UK.
authors.forename: N M
authors.initials: NM
authors.lastname: Brown
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.
authors.forename: D
authors.initials: D
authors.lastname: Limmathurotsakul
authors.affiliation: Department of Medicine, University of Cambridge, UK; Clinical Microbiology and Public Health Laboratory, Public Health England, UK; Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.
authors.forename: S J
authors.initials: SJ
authors.lastname: Peacock
authors.affiliation: Department of Medicine, University of Cambridge, UK; Clinical Microbiology and Public Health Laboratory, Public Health England, UK; Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. Electronic address: et317@cam.ac.uk.
authors.forename: M E
authors.initials: ME
authors.lastname: Török
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
keywords: Bacteraemia; Staphylococcus aureus; infectious disease consultation; outcome; treatment