scholarly journals 185. Does an Infectious Diseases Consultation Improve Clinical Outcomes and Treatment Bundle Adherence for Enterococcal Bacteremia in a Multicenter Healthcare System?

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S201-S201
Author(s):  
Emily A Shephard ◽  
Kristin E Mondy ◽  
Kelly R Reveles ◽  
Theresa Jaso ◽  
Dusten T Rose
Keyword(s):  
Infectious Diseases ◽  
Primary Outcome ◽  
Blood Cultures ◽  
Clinical Failure ◽  
Duration Of Treatment ◽  
Composite Failure ◽  
Staphylococcus Aureus Bacteremia ◽  
Joint Infections ◽  
Infectious Diseases Consultation ◽  
Enterococcal Bacteremia

Abstract Background Infectious diseases consultation (IDC) for Staphylococcus aureus bacteremia has a known mortality benefit, but for other gram positive bacteremias the benefit is not known. This study examined differences in outcomes for enterococcal bacteremia when management includes IDC. Methods This retrospective multicenter observational cohort study included adults with at least 1 positive blood culture with Enterococcus species. Patients who died or transferred to palliative care within 2 days of positive blood cultures were excluded. The primary outcome was a composite of clinical failure, including persistent blood cultures or fever for 5 days and in-hospital mortality. Secondary outcomes included adherence to a treatment bundle (appropriate empiric/definitive antibiotics, echocardiography (ECHO), duration of treatment, and repeat blood cultures). Results A total of 250 patients were included. IDC was obtained in 62.0% of patients. More patients in the IDC group had endocarditis (20% vs 0%, p < 0.0001) and bone and joint infections (13.5% vs 1.1%, p = 0.001), compared to more UTI (16.8% vs 39.0%, p < 0.0001) in the non-IDC group. Patients in the IDC group had more murmurs on initial exam (21.3% vs 6.3%, p = 0.002), prosthetic device (49.7% vs 27.4%, p = 0.001), and NOVA scores of ≥ 4 (40.6% vs 18.9%, p < 0.0001). Most infections were due to E. faecalis (78.4%) and most were susceptible to vancomycin and ampicillin at 90.4% and 92.4%, respectively. The composite of clinical failure occurred in 22.6% of patients with IDC and 16.8% in the non-IDC group (p=0.274). There was higher adherence to the treatment bundle in the IDC group (Figure 1). More patients in the IDC group were treated with ampicillin (47.1% vs 22.1%, p < 0.0001), and numerically more patients received treatment with vancomycin in the non-IDC group (17.4% vs 24.2%, p = 0.068). In the multivariate analysis, vasopressors were the only independent predictor of the primary outcome (OR 9.3, 95% CI 3.5-24.8, p < 0.0001). Figure 1. Adherence to treatment bundle. IDC = infectious diseases consultation, Echo = echocardiogram, * = p < 0.05 Conclusion There was no difference in rates of composite failure in patients with or without IDC; however, adherence to a treatment bundle was higher in the IDC group. IDC demonstrated stewardship benefits with regards to vancomycin usage. Disclosures All Authors: No reported disclosures

scholarly journals The Value of Infectious Diseases Consultation in Staphylococcus aureus Bacteremia

2010 ◽  
Vol 123 (7) ◽  
pp. 631-637 ◽  
Author(s):  
Hitoshi Honda ◽  
Melissa J. Krauss ◽  
Jeffrey C. Jones ◽  
Margaret A. Olsen ◽  
David K. Warren
Keyword(s):  
Staphylococcus Aureus ◽  
Infectious Diseases ◽  
Staphylococcus Aureus Bacteremia ◽  
Infectious Diseases Consultation

Impact of Infectious Diseases Consultation on Management and Outcome of Staphylococcus aureus Bacteremia in Children

2020 ◽  
Author(s):  
Robert C Duguid ◽  
Mohammed Al Reesi ◽  
Adam W Bartlett ◽  
Pamela Palasanthiran ◽  
Brendan J McMullan
Keyword(s):  
Staphylococcus Aureus ◽  
Regression Analysis ◽  
Infectious Diseases ◽  
Multivariate Regression ◽  
Complete Response ◽  
Multivariate Regression Analysis ◽  
Source Control ◽  
Staphylococcus Aureus Bacteremia ◽  
Infectious Diseases Consultation ◽  
The Impact

Abstract Background To examine the impact of infectious diseases consultation (IDC) on the management and outcome of Staphylococcus aureus bacteremia (SAB) in children. Methods A retrospective cohort study of children with SAB at a teritary pediatric hospital (January 2009-June 2015) identified by medical record review as to whether they received an IDC for SAB at the discretion of the admitting physician or surgeon was conducted. Differences in management and outcomes for those with and without IDC were evaluated, and multivariate regression analysis was used to determine factors associated with cure. Results There were 100 patients included in the analysis. Fifty-five patients received IDC and 45 had no IDC (NIDC). Appropriate directed therapy within 24 hours (54/55 = 98.2% vs 34/45 = 75.6%, P < .01), choice (54/55 = 98.2% vs 37/45 = 82.2%, P < .01), dose (54/55 = 98.2% vs 36/45 = 80%, P < .01), and duration (52/55 = 94.5% vs 24/45 = 53.3%, P < .01) of directed antibiotic therapy were appropriate in more IDC group patients. Achievement of source control in indicated cases was also more common in the IDC group (28/32 = 87.5% vs 5/26 = 19.1%, P < .01). Appropriate investigation with repeat blood cultures and echocardiograms was not significantly different. All 55 patients in the IDC group had a complete response (cure) compared with 40 of the 45 (88.9%) patients in the NIDC group: 2 patients died and 3 patients had a relapse of infection with subsequent cure. In multivariate regression analysis, methicillin-susceptible SAB and IDC were factors independently associated with cure. Conclusions Children who received IDC for SAB in a tertiary pediatric setting were more likely to have appropriate investigations and management and had improved outcomes.

Impact of Infectious Diseases Consultation on the Treatment of Staphylococcus aureus Bacteremia

2020 ◽  
Vol 28 (2) ◽  
pp. 67-70 ◽  
Author(s):  
Paul O. Lewis ◽  
Aaryn M. Brewster ◽  
Lamis W. Ibrahim ◽  
Dima A. Youssef ◽  
Susan M. Kullab ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infectious Diseases ◽  
Staphylococcus Aureus Bacteremia ◽  
Infectious Diseases Consultation

scholarly journals 850. Outcomes of Patients Discharged on Parenteral Ceftriaxone Compared with Oxacillin or Cefazolin in Methicillin-susceptible Staphylococcal aureus (MSSA) Bloodstream Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S16-S17
Author(s):  
Lee Erik Connor ◽  
Yasir Hamad ◽  
Ige George
Keyword(s):  
Primary Outcome ◽  
Bloodstream Infections ◽  
Standard Of Care ◽  
Outcome Data ◽  
Blood Cultures ◽  
Clinical Failure ◽  
Median Length ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Group 5 ◽  
Staphylococcal Aureus

Abstract Background MSSA is a leading cause of bloodstream infection (BSI) and its incidence is on the rise. Standard of care (SOC) is prolonged parenteral therapy with nafcillin, oxacillin, or cefazolin. Ceftriaxone is active against MSSA and can be given conveniently as a daily infusion. Methods We conducted a retrospective analysis of hospitalized adults with MSSA BSI from December 2014 to May 2018, defined as ≥1 blood cultures positive for MSSA and discharged on outpatient parenteral antimicrobial therapy (OPAT) on either ceftriaxone, cefazolin, or oxacillin. We excluded patients with ESRD and polymicrobial infections. We collected demographics, comorbidities, outcome data, and treatment-related adverse events. The primary outcome was 90-day mortality with secondary outcomes of clinical failure and microbiologic failure. Clinical failure was defined as readmission for any infection within 90 days of discharge or a change in antibiotics from the planned course of therapy after discharge. Microbiologic failure was defined as reinfection with MSSA within 90 days of discharge from any site. Results In total, 167 patients had a BSI with MSSA. Of those patients, 66 (39.5%) were discharged on SOC and 101 (60.5%) on ceftriaxone. The two groups were similar in terms of their demographics (Table 1). The SOC group had more cases of endocarditis with 34 (51.5%) than ceftriaxone with 25 (24.8%) (P = 0.001). LOS for the SOC group had a median of 14.05 days whereas the ceftriaxone group had a median length of stay of 7.88 (P = 0.004). In the SOC group, 5 (7.6%) patients died compared with 8 (7.9%) patients in the ceftriaxone group within 90 days of the onset of bacteremia which was not statistically significant (P = 0.94) (Figure 1). There were 4 (6.1%) cases of microbiologic failure in SOC and 7 (6.9%) cases in the ceftriaxone group (P = 0.83). For clinical failures, the SOC had 6 (9.1%) cases compared with the 19 (18.8%) cases in the ceftriaxone group (P = 0.13). Conclusion Ceftriaxone was not statistically different when compared with SOC in terms of mortality, microbiologic failure, or clinical failure. Though clinical failures numerically were more frequent in the ceftriaxone group. Ceftriaxone maybe a reasonable and convenient option to SOC for patients with uncomplicated MSSA BSI discharged on OPAT, but further studies are needed. Disclosures All Authors: No reported Disclosures.

Improved mortality in Staphylococcus aureus bacteremia with the involvement of antimicrobial stewardship team and infectious disease consultation

2019 ◽  
Vol 40 (8) ◽  
pp. 932-935 ◽  
Author(s):  
Jacqueline E. Sherbuk ◽  
Dayna McManus ◽  
Jeffrey E. Topal ◽  
Maricar Malinis
Keyword(s):  
Infectious Disease ◽  
Staphylococcus Aureus ◽  
Retrospective Study ◽  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Tertiary Care ◽  
Staphylococcus Aureus Bacteremia ◽  
Infectious Disease Consultation ◽  
Academic Center ◽  
Infectious Diseases Consultation

AbstractA retrospective study was conducted to evaluate the value of the antimicrobial stewardship team (AST) combined with infectious diseases consultation (IDC) on management and outcomes of Staphylococcus aureus bacteremia (SAB) in a tertiary-care academic center. Involvement of AST or IDC was associated with reduced mortality of SAB.

scholarly journals Association of Infectious Diseases Consultation With Long-term Postdischarge Outcomes Among Patients With Staphylococcus aureus Bacteremia

2020 ◽  
Vol 3 (2) ◽  
pp. e1921048
Author(s):  
Michihiko Goto ◽  
Michael P. Jones ◽  
Marin L. Schweizer ◽  
Daniel J. Livorsi ◽  
Eli N. Perencevich ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infectious Diseases ◽  
Staphylococcus Aureus Bacteremia ◽  
Infectious Diseases Consultation
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