Infectious Diseases Consultation Lowers Mortality From Staphylococcus aureus Bacteremia

Lahey, Timothy MD, MMSc; Shah, Ruta MD; Gittzus, Jennifer MD; Schwartzman, Joseph MD; Kirkland, Kathryn MD

doi: 10.1097/MD.0b013e3181b8fccb
Article

Staphylococcus aureus bacteremia (SAB) is a lethal and increasingly common infection in hospitalized patients. We assessed the impact of infectious diseases consultation (IDC) on clinical management and hospital mortality of SAB in 240 hospitalized patients in a retrospective cohort study. Patients who received IDC were older than those who did not (57.9 vs. 51.7 yr; p = 0.05), and were more likely to have a health care-associated infection (63% vs. 45%; p < 0.01). In patients who received IDC, there was a higher prevalence of severe complications of SAB such as central nervous system involvement (5% vs. 0%, p = 0.01), endocarditis (20% vs. 2%; p < 0.01), or osteomyelitis (15.6% vs. 3.4%; p < 0.01). Patients who received IDC had closer blood culture follow-up and better antibiotic selection, and were more likely to have pus or prosthetic material removed. Hospital mortality from SAB was lower in patients who received IDC than in those who did not (13.9% vs. 23.7%; p = 0.05). In multivariate survival analysis, IDC was associated with substantially lower hazard of hospital mortality during SAB (hazard 0.46; p = 0.03). This mortality benefit accrued predominantly in patients with methicillin-resistant SAB (hazard 0.3; p < 0.01), and in patients who did not require ICU admission (hazard 0.15; p = 0.01). In conclusion, IDC is associated with reduced mortality in patients with staphylococcal bacteremia.

Abbreviations: ICU = intensive care unit, IDC = infectious diseases consultation, MRSA = methicillin-resistant Staphylococcus aureus, SAB = Staphylococcus aureus bacteremia.

From Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.

Presented at the 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy/46th Annual Meeting of the Infectious Diseases Society of America, Washington, DC, October 2008.

Received January 5, 2009, and in revised form April 22, 2009.

Accepted for publication July 9, 2009.

Reprints: Timothy Lahey, MD, MMSc, Assistant Professor of Medicine, Section of Infectious Disease and International Health, One Medical Center Drive, Lebanon, NH 03756 (e-mail: Timothy.Lahey@Dartmouth.edu).

© 2009 Lippincott Williams & Wilkins, Inc.