Early Infectious Disease Consultation Is Associated With Lower Mortality in Patients With Severe Sepsis or Septic Shock Who Complete the 3-Hour Sepsis Treatment Bundle

Abstract

Objective Severe sepsis and septic shock (SS/SS) treatment bundles reduce mortality, and early infectious diseases (ID) consultation also improves patient outcomes. We retrospectively examined whether early ID consultation further improves outcomes in Emergency Department (ED) patients with SS/SS who complete the sepsis bundle. Method We included 248 adult ED patients with SS/SS who completed the 3-hour bundle. Patients with ID consultation within 12 hours of ED triage (n = 111; early ID) were compared with patients who received standard care (n = 137) for in-hospital mortality, 30-day readmission, length of hospital stay (LOS), and antibiotic management. A competing risk survival analysis model compared risks of in-hospital mortality and discharge alive between groups. Results In-hospital mortality was lower in the early ID group unadjusted (24.3% vs 38.0%, P = .02) and adjusted for covariates (odds ratio, 0.47; 95% confidence interval (CI), 0.25–0.89; P = .02). There was no significant difference in 30-day readmission (22.6% vs 23.5%, P = .89) or median LOS (10.2 vs 12.1 days, P = .15) among patients who survived. A trend toward shorter time to antibiotic de-escalation in the early ID group (log-rank test P = .07) was observed. Early ID consultation was protective of in-hospital mortality (adjusted subdistribution hazard ratio (asHR), 0.60; 95% CI 0.36–1.00, P = .0497) and predictive of discharge alive (asHR 1.58, 95% CI, 1.11–2.23; P-value .01) after adjustment. Conclusions Among patients receiving the SS/SS bundle, early ID consultation was associated with a 40% risk reduction for in-hospital mortality. The impact of team-based care and de-escalation on SS/SS outcomes warrants further study.

A Propensity Score Matched Study of the Positive Impact of Infectious Diseases Consultation on Antimicrobial Appropriateness in Hospitalized Patients with Antimicrobial Stewardship Oversight

“…Our hospital values the infectious diseases specialty and promotes its influence, as demonstrated by the high penetrance of IDC. In the face of resource limitation, prioritization of IDC in select situations that have demonstrated a benefit of IDC involvement, such as Staphylococcus aureus bacteremia (13,14,16), resistant Enterobacteriaceae infections (17), Pseudomonas bacteremia and candidemia (16), septic shock (18) and high-level antimicrobial prescription (19), may be a suitable approach for some hospitals. Although infectious disease expertise in the form of remote AS prospective audit and feedback (PAF) alone has clear benefits (1-4), our study suggests that IDC improves the use of antimicrobials overall due to expertise brought to the bedside.…”

Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021

“…Given the lack of definitive and generalizable data regarding the optimal duration of therapy for patients who are critically ill, it is not surprising that there is considerably practice variation [281,294]. Specialist consultation appears to be associated with improved patient outcomes for a variety of infectious syndromes [295][296][297][298][299][300]. This has generally been ascribed to improvements in microbial appropriateness of the empiric antimicrobial regimen provided.…”

Comparative effectiveness of early‐targeted use of fidaxomicin versus oral vancomycin among hospitalized veterans’ affairs patients with infections due to Clostridioides difficile

“…Fidaxomicin use was often times accompanied by an infectious diseases consultation, a known predictor of positive outcomes for several infection types. [21][22][23][24] However, receipt of an infectious diseases consult did not confound the association between treatment and the composite outcome in the multivariate analyses. Given the real-world nature of the study, patients who received concomitant CDI antimicrobials were included in the study population.…”