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J Infect. 2016 Jan;72(1):19-28. doi: 10.1016/j.jinf.2015.09.037. Epub 2015 Oct 9.

Infectious disease consultation for Staphylococcus aureus bacteremia - A systematic review and meta-analysis.

Author information

1
Paul Martini Sepsis Research Group, Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.
2
Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany; Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany.
3
Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany; Clinical Epidemiology, Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany.
4
Department of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany.
5
Paul Martini Sepsis Research Group, Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany; Center for Clinical Studies, Jena University Hospital, Jena, Germany; Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany. Electronic address: frank.brunkhorst@med.uni-jena.de.

Abstract

OBJECTIVE:

Mortality and morbidity of Staphylococcus aureus bacteremia (SAB) still remains considerably high. We aimed to evaluate the impact of infectious disease consultation (IDC) on the management and outcomes of patients with SAB.

METHODS:

We systematically searched 3 publication databases from inception to 31st May 2015 and reference lists of identified primary studies.

RESULTS:

Our search returned 2874 reports, of which 18 fulfilled the inclusion criteria, accounting for 5337 patients. Overall 30-day mortality was 19.95% [95% CI 14.37-27.02] with a significant difference in favour of the IDC group (12.39% vs 26.07%) with a relative risk (RR) of 0.53 [95% CI 0.43-0.65]. 90-day mortality and relapse risk for SAB were also reduced significantly with RRs of 0.77 [95% CI 0.64-0.92] and 0.62 [95% CI 0.39-0.99], respectively. Both, the appropriateness of antistaphylococcal agent and treatment duration was improved by IDC (RR 1.14 [95% CI 1.08-1.20] and 1.85 [95% CI 1.39-2.46], respectively). Follow-up blood cultures and echocardiography were performed more frequently following IDC (RR 1.35 [95% CI 1.25-1.46] and 1.98 [95% CI 1.66-2.37], respectively).

CONCLUSIONS:

Evidence-based clinical management enforced by IDC may improve outcome of patients with SAB. Well-designed cluster-randomized controlled trials are needed to confirm this finding from observational studies.

KEYWORDS:

Bacteremia; Infectious disease medicine; Meta-analysis; Mortality; Quality of health care; Staphylococcus aureus

PMID:
26453841
DOI:
10.1016/j.jinf.2015.09.037
[Indexed for MEDLINE]

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