title: Management and outcomes in patients with Staphylococcus aureus bacteremia after implementation of mandatory infectious diseases consult: a before/after study.
abstract: BACKGROUND
  Infectious disease (ID) consultations have been shown to increase adherence to guidelines and decrease mortality for patients with Staphylococcus aureus bacteremia (SAB). Here, we assessed the impact of a mandatory ID consultation policy for SAB.
  
  
  METHODS
  We retrospectively reviewed all consecutive adult patients with SAB at two tertiary care teaching hospitals in Hamilton, ON, Canada. Mandatory ID consults for SAB were implemented on January 1(st) 2012. We compared SAB cases in 2011 (control group) with those in 2012 (intervention group). Outcomes included adherence to the Infectious Diseases Society of America guidelines and patient outcomes.
  
  
  RESULTS
  We reviewed 128 SAB cases in 2011 and 124 in 2012. The majority of S. aureus were methicillin-susceptible (97/128, 75.8 % in 2011 and 100/124, 80.6 % in 2012). ID involvement increased significantly from 93/128 (72.7 %) in 2011, to 103/124 (83.1 %) in 2012 (odds ratio [OR] 1.9, 95 % confidence interval [CI] 1.1-3.3, p = 0.047). There was also a significant decrease in the median time to ID involvement from 2 days to 1 (p = 0.001). In patients who survived the minimum treatment course (greater than 13 days), there was a significant improvement in adherence to IDSA guidelines in 2012 (65/102, 63.7 % vs. 77/96, 80.2 %; OR 2.3, 95 % CI 1.2-4.4, p = 0.01). Mortality and SAB relapse rates were similar in both groups.
  
  
  CONCLUSIONS
  Creating an automated ID consultation for SAB led to an increase in involvement of ID, a significant decrease in time to ID involvement, and better adherence to IDSA guidelines. The study was not sufficiently powered to detect significant changes in mortality and SAB relapse rates.
authors.affiliation: Department of Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: Leslie
authors.initials: L
authors.lastname: Martin
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Miriam Tova
authors.initials: MT
authors.lastname: Harris
authors.affiliation: Department of Medicine, McMaster University, Hamilton, ON, Canada.|Hamilton Health Sciences, Juravinski Hospital and Cancer Center, 711 Concession Street, Section M, Level 1, Room 3, Hamilton, ON, L8V 1C3, Canada.
authors.forename: Annie
authors.initials: A
authors.lastname: Brooks
authors.affiliation: Hamilton Health Sciences, Juravinski Hospital and Cancer Center, 711 Concession Street, Section M, Level 1, Room 3, Hamilton, ON, L8V 1C3, Canada.|Department of Pathology and Laboratory Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Main
authors.affiliation: Department of Medicine, McMaster University, Hamilton, ON, Canada. mertzd@mcmaster.ca.|Hamilton Health Sciences, Juravinski Hospital and Cancer Center, 711 Concession Street, Section M, Level 1, Room 3, Hamilton, ON, L8V 1C3, Canada. mertzd@mcmaster.ca.|Department of Pathology and Laboratory Medicine, McMaster University, Hamilton, ON, Canada. mertzd@mcmaster.ca.|Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. mertzd@mcmaster.ca.|Michael G. DeGroote, Institute for Infectious Diseases Research, McMaster University, Hamilton, ON, Canada. mertzd@mcmaster.ca.
authors.forename: Dominik
authors.initials: D
authors.lastname: Mertz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D002170:Canada; D005260:Female; D033161:Government Regulation; D017052:Hospital Mortality; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents