Guideline compliance and clinical outcomes among patients with Staphylococcus aureus bacteremia with infectious diseases consultation in addition to antimicrobial stewardship-directed review.

OBJECTIVE

Previous studies have shown infectious diseases consultation (IDC) for Staphylococcus aureus bacteremia (SAB) improves management and outcomes. The influence of IDC on outcomes for SAB in addition to an antimicrobial stewardship program (ASP) review for adult inpatients with SAB has not been evaluated. The purpose of this study was to investigate the effect of IDC on SAB management with concomitant ASP review and resulting outcomes.

METHODS

Adult inpatients with SAB admitted December 2012-October 2014 were included. The primary end point compared adherence to Infectious Disease Society of America guideline recommendations between patients receiving an IDC versus those not receiving an IDC. We also evaluated adherence to the individual components of the primary end point and clinical outcomes, including time to microbiologic clearance, recurrence of bacteremia, mortality, and length of stay.

RESULTS

This study included 154 patients (115 IDC and 39 non-IDC). Guideline adherence was significantly greater in the IDC group 78% versus 46% in the non-IDC group (P < .001). Significantly more patients in the IDC group had echocardiography (91% vs 67%; P < .001) and follow-up blood cultures (92% vs 64%; P > .001). Mortality was also greater in the non-IDC group (23%) versus 5% for the IDC group (P = .001).

CONCLUSIONS

Patients with SAB receiving an IDC were more likely to receive guideline-congruent management and had significantly reduced mortality. No improvements in antibiotic choice or dosing were observed, likely a result of ASP review.