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J Infect. 2014 Sep;69(3):226-34. doi: 10.1016/j.jinf.2014.05.004. Epub 2014 May 15.

Mandatory infectious diseases consultation for MRSA bacteremia is associated with reduced mortality.

Author information

1
Infectious Diseases Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland. Electronic address: frederic.tissot@chuv.ch.
2
Infectious Diseases Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland.
3
Institute of Microbiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland.
4
Institute for Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland.
5
Infectious Diseases Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Service of Hospital Preventive Medicine, Department of Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland.
6
Infectious Diseases Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland; Institute of Microbiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland.

Abstract

OBJECTIVES:

Although infectious disease (ID) consultation has been associated with lower mortality in Staphylococcus aureus bloodstream infections, it is still not mandatory in many centers. This study aimed at assessing the impact of ID consultation on diagnostic and therapeutic management of methicillin-resistant S. aureus (MRSA) bacteremia.

METHODS:

Retrospective cohort study of all patients with MRSA bacteremia from 2001 to 2010. ID consultations were obtained on request between 2001 and 2006 and became mandatory since 2007.

RESULTS:

156 episodes of MRSA bacteremia were included, mostly from central venous catheter (32%) and skin and soft tissue (19%) infections. ID consultation coverage was 58% between 2001 and 2006 and 91% between 2007 and 2010. ID consultation was associated with more echocardiography (59% vs. 26%, p < 0.01), vancomycin trough level measurements (99% vs. 77%, p < 0.01), follow-up blood cultures (71% vs. 50%, p = 0.05), deep-seated infections (43% vs. 16%, p < 0.01), more frequent infection source control (83% vs. 57%, p = 0.03), a longer duration of MRSA-active therapy (median and IQR: 17 days, 13-30, vs. 12, 3-14, p < 0.01) and a 20% reduction in 7-day, 30-day and in-hospital mortality.

CONCLUSIONS:

ID consultation was associated with a better management of patients with MRSA bacteremia and a reduced mortality.

KEYWORDS:

Bloodstream infection; Infectious diseases consultation; MRSA; Outcome

PMID:
24844825
DOI:
10.1016/j.jinf.2014.05.004
[Indexed for MEDLINE]
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