Telephone Consultation Cannot Replace Bedside Infectious Disease Consultation in the Management of Staphylococcus aureus Bacteremia

Forsblom, Erik; Ruotsalainen, Eeva; Ollgren, Jukka; Järvinen, Asko

doi:10.1093/cid/cis889

Cited by 114 publications

(150 citation statements)

References 26 publications

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“…Second, while this was a multihospital study, the main intervention was performed by only four or five infectious diseases specialists, and outcomes at other community hospitals may differ. In contrast to our setting, not all community hospitals have IDC available or they may have access only to telephone consultation, which was shown previously to be suboptimal (20). While most of the data, including the primary outcomes, were extracted objectively from electronic health records, other information (such as Pitt bacteremia scores and findings regarding complicated versus uncomplicated bacteremia) had to be collected manually.…”

Section: Discussionmentioning

confidence: 99%

Impact of Infectious Diseases Consultation on Clinical Outcomes of Patients with Staphylococcus aureus Bacteremia in a Community Health System

Turner

Valcarlos

Won

et al. 2016

Antimicrob Agents Chemother

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c Staphylococcus aureus bacteremia (SAB) causes high rates of morbidity and death. Several studies in academic health settings have demonstrated that consultations from infectious diseases specialists improve the quality of care and clinical outcomes for SAB. Few data that describe the impact in resource-limited settings such as community hospitals are available. This retrospective cohort study evaluated the adherence to quality-of-care indicators and the clinical outcomes for SAB in a five-hospital community health system (range of 95 to 272 available beds per hospital), for patients with versus without infectious diseases consultation (IDC). IDC was provided if requested by the attending physician. The primary outcome was the incidence of treatment failure, defined as 30-day in-hospital death or 90-day SAB recurrence. Other outcomes included adherence to quality-of-care indicators. A total of 473 adult patients with SAB were included, with 369 (78%) receiving IDC. We identified substantial differences in baseline characteristics between the IDC group and the no-IDC group, including greater incidences of complicated bacteremia and intravenous drug users in the IDC group, with similar rates of severe illness (measured by Pitt bacteremia scores). Adherence to quality-of-care indicators was greater for patients with IDC (P < 0.001). After adjustment for other predicting variables, IDC was associated with a lower rate of treatment failure (adjusted odds ratio, 0.42 [95% confidence interval, 0.20 to 0.86]; P ‫؍‬ 0.018). IDC provided better quality of care and better clinical outcomes for patients with SAB who were treated at small, resource-limited, community hospitals. Staphylococcus aureus is the most common bacterial pathogen isolated from inpatient cultures and the second most common in outpatient cultures (1). S. aureus bacteremia (SAB) is associated with significant morbidity and demonstrates attributable mortality rates of 10 to 30% (2-7). Management of SAB can be challenging, as quality-of-care indicators include identification and removal of infectious foci, collection of repeat blood cultures until resolution of bacteremia, echocardiography, differentiation of complicated and uncomplicated bacteremia, and selection of appropriate intravenous (i.v.) treatment and duration (8). Infectious diseases consultation (IDC) has been associated with greater adherence to these quality-ofcare indicators (4-7, 9, 10), with some studies also demonstrating lower mortality rates (4, 5). The vast majority of studies evaluating this impact have been conducted at large academic hospitals, with few data from resource-limited settings such as community and rural hospitals. Community hospitals may differ from academic hospitals in patient volumes, patient characteristics, available resources, and clinical outcomes for certain medical conditions (11)(12)(13)(14). Because substantial differences may exist, study of the impact of IDC on the outcomes of patients with SAB in community hospitals is necessary. We conducted a retrospect...

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Section: Discussionmentioning

confidence: 99%

Impact of Infectious Diseases Consultation on Clinical Outcomes of Patients with Staphylococcus aureus Bacteremia in a Community Health System

Turner

Valcarlos

Won

et al. 2016

Antimicrob Agents Chemother

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“…Consultation with an infectious disease specialist is important for improving the proper selection of antimicrobial agents, altering the therapy duration, and improving the outcome in cases involving infectious diseases [11,12]. In particular, it was noted that bedside consultation, defined as an infectious disease specialist writing comments regarding the patient's status (based on the results of a physical examination) into in their patient record, is superior to telephone-based consultation [13]. Prior to 2013, most of the decisions regarding the management of antimicrobial treatment in our pediatric ward were made by non-specialists.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of the direct clinical intervention for infectious diseases by a pediatric infectious disease specialist in the pediatric ward of a tertiary medical facility without a pediatric antimicrobial stewardship program

Hoshina

Yamamoto

Ogawa

et al. 2017

Eur J Clin Microbiol Infect Dis

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Antimicrobial stewardship programs (ASPs) have been introduced in most hospital complexes; however, they are not always useful for pediatric patients. The aim of this study is to investigate the efficacy of direct clinical intervention for infectious diseases by a pediatric infectious disease specialist in a tertiary medical facility without pediatric ASP. This retrospective study included 1,821 patients who were hospitalized in the pediatric ward of a large metropolitan hospital from 2010 to 2015. The clinical course, the use of intravenous antimicrobial agents and the results of a microbiological analysis were compared between the period after the beginning of direct intervention by the specialist (post-intervention period) and the previous period (pre-intervention period). In the post-intervention period, the proportion of the patients who received intravenous antimicrobial agents, the number of antimicrobial agents used for each episode, and the proportion of episodes in which an antimicrobial agent was re-administrated were significantly lower (P = 0.006, P = 0.004, P = 0.036, respectively), and the duration of antimicrobial treatment was significantly shorter (P < 0.001). In addition, narrower spectrum antimicrobial agents were used, and the incidence of meropenem-sensitive Pseudomonas aeruginosa significantly increased (P = 0.037) in the post-intervention period. There was no change of mortality between the two periods. Direct clinical intervention by a pediatric infectious diseases specialist is useful for the treatment of infectious diseases in the pediatric ward of a tertiary medical facility without a pediatric ASP. The creation of a pediatric ASP is recommended in hospital complexes.

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“…The prognosis of SAB is impaired by high age [2–5], hemodynamic instability [2–4] and complications like endocarditis or pneumonia [2–4] whereas deep infection focus identification [4,5] and infectious disease specialist consultation have improved outcome [2,3,5]. Despite advances in SAB management, mortality remains high, ranging from 20%-32% in recent studies [2,3].…”

Section: Introductionmentioning

confidence: 99%

“…Median antimicrobial treatment durations in previous reports have been at least 2 week [8,9]. Recent studies have demonstrated that a vast amount of deep infection foci are present already within 3 days [4] and up to 80% of SAB patients present with a deep infection focus [4,5,13]. Furthermore, meticulous deep infection focus localization and infectious disease specialist consultations are known to improved SAB prognosis [2,4,5,13].…”

Section: Introductionmentioning

confidence: 99%

Comparable Effectiveness of First Week Treatment with Anti-Staphylococcal Penicillin versus Cephalosporin in Methicillin-Sensitive Staphylococcus aureus Bacteremia: A Propensity-Score Adjusted Retrospective Study

Forsblom¹,

Ruotsalainen²,

Järvinen³

2016

PLoS ONE

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The objective was to compare the prognostic impact of first week treatment with anti-staphylococcal penicillin (ASP) versus cephalosporin in methicillin-sensitive Staphylococcus aureus bacteremia (MS-SAB). Altogether 580 patients were retrospectively followed and categorized according to first week treatment; 84% (488) received ASP (cloxacillin) and 16% (92) cephalosporin (cefuroxime or ceftriaxone). SAB management was optimized with formal bedside infectious disease specialist consultation in 88%, deep infection foci diagnosed in 77% and adjunctive rifampicin therapy given to 61% of patients. The total case fatality in 580 patients was 12% at 28 days and 18% at 90 days. When comparing effectiveness of first week ASP versus cephalosporin treatment there were no significant differences in 28-days (11% vs. 12%, OR; 1.05, 95% CI, 0.53–2.09) or 90-days (17% vs. 21% OR; 1.25, 95% CI, 0.72–2.19) outcome. In univariate analysis no prognostic impact of either first week ASP or cephalosporin treatment was observed for 28-days (OR; 0.96, 95% CI, 0.48–1.90 and OR; 1.05, 95% CI, 0.53–2.09) or 90-days (OR; 0.80, 95% CI, 0.46–1.39 and OR; 1.25, 95% CI, 0.72–2.19) outcome. Propensity-score adjusted Cox proportional regression analysis for first week treatment with cephalosporin demonstrated no significant prognostic impact at 28-days (HR 1.54, 95% CI 0.72–3.23) or 90-days (HR 1.56, 95% CI 0.88–2.86). In conclusion: There is a comparable effectiveness with respect to 28- and 90-days outcome for first week treatment with ASP versus cephalosporin in MS-SAB. The results indicate that the difference in prognostic impact between first week ASP and cephalosporin may be non-significant in patient cohorts with SAB management optimized by infectious disease specialist consultation.

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Telephone Consultation Cannot Replace Bedside Infectious Disease Consultation in the Management of Staphylococcus aureus Bacteremia

Abstract: Telephone IDS consultation is inferior to bedside IDS consultation.

Cited by 114 publications

References 26 publications

Impact of Infectious Diseases Consultation on Clinical Outcomes of Patients with Staphylococcus aureus Bacteremia in a Community Health System

Impact of Infectious Diseases Consultation on Clinical Outcomes of Patients with Staphylococcus aureus Bacteremia in a Community Health System

The efficacy of the direct clinical intervention for infectious diseases by a pediatric infectious disease specialist in the pediatric ward of a tertiary medical facility without a pediatric antimicrobial stewardship program

Comparable Effectiveness of First Week Treatment with Anti-Staphylococcal Penicillin versus Cephalosporin in Methicillin-Sensitive Staphylococcus aureus Bacteremia: A Propensity-Score Adjusted Retrospective Study

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