Infectious Disease Consultation Lowers Risk of Bloodstream Infection Mortality

Among patients with common bloodstream infections, lack of infectious disease consultation was associated with a more than fourfold increased hazard of death at three months.

Bloodstream infections result in high morbidity and mortality. Multiple studies have demonstrated that infectious diseases (ID) consultation is associated with improved outcomes, especially in Staphylococcus aureus bacteremia and candidemia.

Infectious disease specialists at the University of Minnesota Medical Center (Minneapolis, MN, USA) performed a retrospective cohort study of bloodstream infections at the referral center. They investigated the impact of ID consultation, which they noted is not mandatory at all facilities, on the mortality of patients hospitalized with Methicillin-resistant S. aureus (MRSA), Candida and Pseudomonas bloodstream infections. As part of the analysis, they recorded whether an ID consultation note was present in the electronic medical record, when patients received appropriate antibiotics and whether the hospitalization included an intensive care unit (ICU) stay.

The team identified 229 bloodstream infections between 2016 and 2018: 99 with MRSA, 69 with Candida and 61 with Pseudomonas. Of these, 181 had an ID consultation. Their analysis showed that patients without ID consultation had a 4.5 increased hazard of death at three months compared with those who received ID consultation. Among MRSA infections, mortality with ID consultation was 22% compared with 67% without, and the median time to death in those without an ID consultation was two days compared with 27 days in patients who received a consultation. Among patients with candidemia infection, the doctors found that without ID consultation, 63% died, compared with 32% of patients who received an ID consultation. The rate of mortality at three months was 63% among patients with Pseudomonas bacteremia infection who did not receive an ID consultation, compared with 32% who did.

Additionally, the team found that patients who received ID consultation were nine times more likely receive appropriate antibiotics or antifungals, six times more likely to have central lines removed and four times more likely to have echocardiography performed to evaluate patients for endocarditis. Supavit Chesdachai, MD, an internal medicine resident and first author of the study, said, “Bloodstream infections result in high morbidity and mortality. Multiple studies have demonstrated that infectious diseases consultation is associated with improved outcomes, especially in S. aureus bacteremia and candidemia.”

The investigators concluded that their study demonstrated that ID consultation is associated with significantly lower three-month mortality and lower inpatient mortality in persons with bloodstream infections. The benefit of ID consultation was found for MRSA, candidemia, and extended to Pseudomonas bacteremia. Automatic ID consultation may have the potential to improve patient survival; prospective evaluation of such an intervention is warranted. The study was published on January 11, 2020 in the journal Open Forum Infectious Diseases.

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