title: Infectious disease consultation for Staphylococcus aureus bacteremia - A systematic review and meta-analysis.
abstract: OBJECTIVE
  Mortality and morbidity of Staphylococcus aureus bacteremia (SAB) still remains considerably high. We aimed to evaluate the impact of infectious disease consultation (IDC) on the management and outcomes of patients with SAB.
  
  
  METHODS
  We systematically searched 3 publication databases from inception to 31st May 2015 and reference lists of identified primary studies.
  
  
  RESULTS
  Our search returned 2874 reports, of which 18 fulfilled the inclusion criteria, accounting for 5337 patients. Overall 30-day mortality was 19.95% [95% CI 14.37-27.02] with a significant difference in favour of the IDC group (12.39% vs 26.07%) with a relative risk (RR) of 0.53 [95% CI 0.43-0.65]. 90-day mortality and relapse risk for SAB were also reduced significantly with RRs of 0.77 [95% CI 0.64-0.92] and 0.62 [95% CI 0.39-0.99], respectively. Both, the appropriateness of antistaphylococcal agent and treatment duration was improved by IDC (RR 1.14 [95% CI 1.08-1.20] and 1.85 [95% CI 1.39-2.46], respectively). Follow-up blood cultures and echocardiography were performed more frequently following IDC (RR 1.35 [95% CI 1.25-1.46] and 1.98 [95% CI 1.66-2.37], respectively).
  
  
  CONCLUSIONS
  Evidence-based clinical management enforced by IDC may improve outcome of patients with SAB. Well-designed cluster-randomized controlled trials are needed to confirm this finding from observational studies.
authors.affiliation: Paul Martini Sepsis Research Group, Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.
authors.forename: Monique
authors.initials: M
authors.lastname: Vogel
authors.affiliation: Paul Martini Sepsis Research Group, Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.
authors.forename: Roland P H
authors.initials: RP
authors.lastname: Schmitz
authors.affiliation: Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany; Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hagel
authors.affiliation: Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany; Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany.
authors.forename: Mathias W
authors.initials: MW
authors.lastname: Pletz
authors.affiliation: Paul Martini Sepsis Research Group, Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.
authors.forename: Nico
authors.initials: N
authors.lastname: Gagelmann
authors.affiliation: Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany; Clinical Epidemiology, Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany.
authors.forename: André
authors.initials: A
authors.lastname: Scherag
authors.affiliation: Department of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Schlattmann
authors.affiliation: Paul Martini Sepsis Research Group, Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany; Center for Clinical Studies, Jena University Hospital, Jena, Germany; Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany. Electronic address: frank.brunkhorst@med.uni-jena.de.
authors.forename: Frank M
authors.initials: FM
authors.lastname: Brunkhorst
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000453:epidemiology* / Q000401:mortality; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000401:mortality; D013211:Staphylococcus aureus
keywords: Bacteremia; Infectious disease medicine; Meta-analysis; Mortality; Quality of health care; Staphylococcus aureus