Infectious disease consultation for Staphylococcus aureus bacteremia – A systematic review and meta-analysis

Vogel, Monique; Schmitz, Roland; Hagel, Stefan; Pletz, Mathias W.; Gagelmann, Nico; Scherag, André; Schlattmann, Peter; Brunkhorst, Frank M.

doi:10.1016/j.jinf.2015.09.037

Cited by 190 publications

(151 citation statements)

References 44 publications

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“…The situation in our hospital reflects the situation of many hospitals, and this intervention can easily be implemented in many other hospitals. In our knowledge, this study is among the largest studies performed in the setting of a general hospital [23]. …”

Section: Discussionmentioning

confidence: 99%

Implementing a hospital-wide protocol for Staphylococcus aureus bacteremia

Bolhuis

Bakker

Keijer

et al. 2018

Eur J Clin Microbiol Infect Dis

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Staphylococcus aureus bacteraemia (SAB) is associated with high-mortality and complication rates. A multidisciplinary approach is needed to predict, detect and treat complications. In this pre- and post-intervention study, we investigated the effects of a hospital-wide protocol for diagnosis, classification and treatment of SAB. It was hypothesized that complications and endocarditis would be better identified and treated. Medical records of SAB patients admitted in 2011 and 2012 (pre) were analysed. In 2013, a protocol, describing risk factors, diagnostic classification and recommended treatment, was implemented. In 2014 and 2015 (post), SAB patients were followed prospectively. Transthoracic (TTE) or transoesophageal cardiac ultrasound (TEE) was chosen following a decision tree. A resident internal medicine acted as contact person. Pre-intervention, 98 patients were eligible for analysis compared to 85 patients post-intervention. Age and number of risk factors were slightly higher post-intervention; other baseline characteristics were similar. Most SAB-patients were classified as complicated (89 and 82% pre- and post-intervention, respectively). Follow-up blood cultures drawn within 2 days after initiating treatment increased from 51 to 85%. Cardiac ultrasounds increased from 44 to 83% for TTE and 13 to 24% for TEE. Endocarditis was more frequently diagnosed (4 vs. 12%). Additionally, duration of antibiotic therapy increased. The 3-month mortality did not change significantly (33% pre-intervention vs. 35% post-intervention; p > 0.05). Introduction of a hospital-wide protocol for SAB management increased standard of care, created awareness among clinicians to properly classify SAB, search for endocarditis and adapt duration of antibiotic treatment. Mortality did not decrease.

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Section: Discussionmentioning

confidence: 99%

Implementing a hospital-wide protocol for Staphylococcus aureus bacteremia

Bolhuis

Bakker

Keijer

et al. 2018

Eur J Clin Microbiol Infect Dis

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“…Additionally, echocardiography may not directly influence treatment but could indicate better adherence to guidelines in the treatment of SaB such as more appropriate screening for sources of infection and choice/duration of antibiotics. In a meta‐analysis, Vogel et al showed that infectious disease consultation in patients with SaB decreased mortality. This was attributed to better adherence to guidelines including more frequent use of echocardiography.…”

Section: Discussionmentioning

confidence: 99%

Trends in the use of echocardiography in patients with Staphylococcus aureus bacteremia: an analysis using the Nationwide Inpatient Sample data

et al. 2019

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Background Infective endocarditis occurs in approximately 10%‐30% of patients with Staphylococcus aureus bacteremia (SaB). Guidelines recommend echocardiography in patients with SaB and risk factors for infective endocarditis in the absence of any obvious source of infection. Herein, we explored the trends in the use of echocardiography in patients with SaB and its relationship to outcomes using a large national database. Method All patients with a principal discharge diagnosis of SaB were identified using the National Inpatient Sample database from 2001 to 2014. Procedure code 88.72 was used to identify echocardiography. Logistic regression models were estimated to identify the year‐over‐year trends in echocardiogram, predictors of use, and association with mortality. Results From 2001 to 2014, there were 668 423 hospitalizations with SaB diagnosis and 86 387 (12.9%) had echocardiogram. The rate of echocardiography increased from 10.7% in 2001 to 15.2% in 2014 (ptrend < 0.001). Major predictors of echocardiogram usage were younger age, male gender, presence of sepsis, valvular or congenital heart disease, prosthetic heart valve (PHV), cardiac implantable electronic device (CIED), hemodialysis, and drug abuse. The adjusted rates of echocardiography increased from approximately 10% to 15% in hospitalizations without risk factors for IE while for high‐risk groups like PHV and CIED it remained constant at 30% and 19%, respectively. Echocardiography was associated with 31% lower odds of in‐hospital mortality. Conclusion The increase in echocardiography rate was largely attributable to increased use in those without risk factors while usage in those with PHV and CIED remained much lower than expected. Echocardiography use was associated with lower risk‐adjusted mortality. These findings require further study and confirmation.

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“…Low ID involvement and a priority towards multidrug-resistant Gram-negatives are possible reasons for a reduced first-line use of anti-MRSA compounds in the ICU. Although ICU patients displayed higher rates of inadequate first-line therapy and risk factors associated with increased mortality (e.g., reduced ID consultation and endocarditis) [6], overall mortality was comparable between groups. This may be related to a limited number of patients with septic shock in the ICU group; furthermore, low Charlson scores and higher source control in the ICU group compared with the non-ICU group may have contributed to achieve positive outcomes.…”

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confidence: 99%