scholarly journals Impact of Mandatory Infectious Diseases Consultation and Real-time Antimicrobial Stewardship Pharmacist Intervention on Staphylococcus aureus Bacteremia Bundle Adherence

2020 ◽  
Vol 7 (6) ◽  
Author(s):  
Kellie Arensman ◽  
Jennifer Dela-Pena ◽  
Jessica L Miller ◽  
Erik LaChance ◽  
Maya Beganovic ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infectious Diseases ◽  
Real Time ◽  
Antimicrobial Stewardship ◽  
Source Control ◽  
Staphylococcus Aureus Bacteremia ◽  
Period 2 ◽  
Review Period ◽  
Infectious Diseases Consultation ◽  
The Impact

Abstract Background The purpose of this study was to evaluate the impact of infectious diseases consultation (IDC) and a real-time antimicrobial stewardship (AMS) review on the management of Staphylococcus aureus bacteremia (SAB). Methods This retrospective study included adult inpatients with SAB from January 2016 to December 2018 at 7 hospitals. Outcomes were compared between 3 time periods: before mandatory IDC and AMS review (period 1), after mandatory IDC and before AMS review (period 2), and after mandatory IDC and AMS review (period 3). The primary outcome was bundle adherence, defined as appropriate intravenous antimicrobial therapy, appropriate duration of therapy, appropriate surveillance cultures, echocardiography, and removal of indwelling intravenous catheters, if applicable. Secondary end points included individual bundle components, source control, length of stay (LOS), 30-day bacteremia-related readmission, and in-hospital all-cause mortality. Results A total of 579 patients met inclusion criteria for analysis. Complete bundle adherence was 65% in period 1 (n = 241/371), 54% in period 2 (n = 47/87), and 76% in period 3 (n = 92/121). Relative to period 3, bundle adherence was significantly lower in period 1 (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.37–0.93; P = .02) and period 2 (OR, 0.37; 95% CI, 0.20–0.67; P = .0009). No difference in bundle adherence was noted between periods 1 and 2. Significant differences were seen in obtaining echocardiography (91% vs 83% vs 100%; P < .001), source control (34% vs 45% vs 45%; P = .04), and hospital LOS (10.5 vs 8.9 vs 12.0 days; P = .01). No differences were noted for readmission or mortality. Conclusions The addition of AMS pharmacist review to mandatory IDC was associated with significantly improved quality care bundle adherence.

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.

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 1041. Staphylococcus aureus Bacteremia Bundle Adherence Pre- and Post-Implementation of Mandatory Infectious Diseases Consultation and Antimicrobial Stewardship Pharmacist Intervention

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S366-S367
Author(s):  
Kellie Arensman ◽  
Jennifer Dela-Pena ◽  
Jessica Miller ◽  
Erik LaChance ◽  
Maya Beganovic ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Source Control ◽  
Care Bundle ◽  
Review Group ◽  
Staphylococcus Aureus Bacteremia ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Infectious diseases consult (IDC) and antimicrobial stewardship (AMS) intervention independently demonstrate improved management of Staphylococcus aureus bacteremia (SAB). However, data supporting utilizing both strategies is limited. The objective of the current study is to assess evidence-based bundle adherence for SAB in the presence and absence of mandatory IDC and AMS pharmacist review in a multi-site health system. Methods This retrospective study included adult inpatients with SAB from January 2016 to December 2018 at seven hospitals. Outcomes were compared between three groups: pre-mandatory IDC and AMS review (group 1), post-mandatory IDC and pre-AMS review (group 2), and post-mandatory IDC and AMS review (group 3). The primary outcome was bundle adherence defined as: appropriate intravenous antimicrobial therapy, appropriate duration of therapy, 24–48-hour surveillance cultures until documented clearance, echocardiography, and removal of indwelling intravenous catheters, if applicable. Secondary endpoints included individual bundle components, source control, length of stay (LOS), 30-day bacteremia-related readmission, and in-hospital all-cause mortality. Results A total of 579 patients met the final inclusion criteria for analysis. Complete bundle adherence was achieved in 65% of patients for group 1 (n = 371), 54% for group 2 (n = 87), and 76% for group 3 (n = 121). Adherence to bundle elements was significantly higher in group 3 when compared with group 1 (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.37–0.93), and group 2 (OR 0.37, 95% CI 0.20 – 0.67). No difference in bundle adherence was noted between groups 1 and 2. When comparing groups 1, 2 and 3, significant differences were seen in obtaining echocardiography (91% vs. 83% vs. 100%; P = 0.0378), and hospital LOS (10.5 vs. 8.85 vs. 12.0 days; P = 0.0149), respectively. Increased hospital LOS in group 3 may be due to nonsignificant higher rates of complicated bacteremia compared with groups 2 and 1 (32% vs. 44% vs. 43%, P = 0.09), respectively. No differences were noted for readmission or mortality. Conclusion The addition of AMS pharmacist review to mandatory IDC significantly improved quality care bundle adherence. Disclosures All authors: No reported disclosures.

scholarly journals Staphylococcus aureus Bacteremia: The Impact of Infectious Diseases Consultation at a Large Urban Hospital

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Charles Kyriakos Vorkas ◽  
Shashi Kapadia ◽  
Thomas Baker ◽  
Kristen M. Marks ◽  
Ole Vielemeyer
Keyword(s):  
Staphylococcus Aureus ◽  
Infectious Diseases ◽  
Urban Hospital ◽  
Staphylococcus Aureus Bacteremia ◽  
Infectious Diseases Consultation ◽  
The Impact

scholarly journals The impact of infectious diseases consultation on the management and outcomes of Pseudomonas aeruginosa bacteraemia in adults: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fabian Chiong ◽  
Mohammed S. Wasef ◽  
Kwee Chin Liew ◽  
Raquel Cowan ◽  
Danny Tsai ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Infectious Diseases ◽  
Retrospective Cohort ◽  
Source Control ◽  
First Episode ◽  
Oral Antibiotic ◽  
Genotypic Analysis ◽  
Infectious Diseases Consultation ◽  
Staphylococcal Aureus ◽  
The Impact

Abstract Background Pseudomonas aeruginosa bacteraemia (PAB) is associated with high mortality. The benefits of infectious diseases consultation (IDC) has been demonstrated in Staphylococcal aureus bacteraemia and other complex infections. Impact of IDC in PAB is unclear. This study aimed to evaluate the impact of IDC on the management and outcomes in patients with PAB. Methods This is a retrospective cohort single-centre study from 1 November 2006 to 29 May 2019, in all adult patients admitted with first episode of PAB. Data collected included demographics, clinical management and outcomes for PAB and whether IDC occurred. In addition, 29 Pseudomonas aeruginosa (PA) stored isolates were available for Illumina whole genome sequencing to investigate if pathogen factors contributed to the mortality. Results A total of 128 cases of PAB were identified, 71% received IDC. Patients who received IDC were less likely to receive inappropriate duration of antibiotic therapy (4.4%; vs 67.6%; p < 0.01), more likely to be de-escalated to oral antibiotic in a timely manner (87.9% vs 40.5%; p < 0.01), undergo removal of infected catheter (27.5% vs 13.5%; p = 0.049) and undergo surgical intervention (20.9% vs 5.4%, p = 0.023) for source control. The overall 30-day all-cause mortality rate was 24.2% and was significantly higher in the no IDC group in both unadjusted (56.8% vs 11.0%, odds ratio [OR] = 10.63, p < 0.001) and adjusted analysis (adjusted OR = 7.84; 95% confidence interval, 2.95–20.86). The genotypic analysis did not reveal any PA genetic features associated with increased mortality between IDC versus no IDC groups. Conclusion Patients who received IDC for PAB had lower 30-day mortality, better source control and management was more compliant with guidelines. Further prospective studies are necessary to determine if these results can be validated in other settings.

scholarly journals A Propensity Score Matched Study of the Positive Impact of Infectious Diseases Consultation on Antimicrobial Appropriateness in Hospitalized Patients with Antimicrobial Stewardship Oversight

2020 ◽  
Vol 64 (8) ◽  
Author(s):  
Jacqueline T. Bork ◽  
Kimberly C. Claeys ◽  
Emily L. Heil ◽  
Mary Banoub ◽  
Surbhi Leekha ◽  
...  
Keyword(s):  
Propensity Score ◽  
Infectious Diseases ◽  
Propensity Score Matching ◽  
Antimicrobial Stewardship ◽  
Positive Impact ◽  
Hospitalized Patients ◽  
Audit And Feedback ◽  
Medical Specialties ◽  
Infectious Diseases Consultation ◽  
The Impact

ABSTRACT Hospital-based antibiotic stewardship (AS) programs provide oversight and guidance for appropriate antimicrobial use in acute care settings. Infectious disease expertise is beneficial in the care of hospitalized patients with infections. The impact of infectious diseases consultation (IDC) on antimicrobial appropriateness in a large tertiary hospital with an established AS program was investigated. This was a cross-sectional study from October 2017 to March 2019 at a large academic hospital with an AS-directed prospective audit and feedback process and multiple IDC services. Antimicrobial appropriateness was adjudicated by an AS team member after antimicrobial start. Antimicrobial appropriateness was compared among antimicrobial orders with and without IDC using propensity score matching and multivariable logistic regression. Analyses were stratified by primary services caring for the patients. There were 10,508 antimicrobial orders from 6,165 unique patient encounters. Overall appropriateness was 92%, with higher appropriateness among patients with IDC versus without IDC (94% versus 84%; P < 0.0001). After propensity score matching and adjustment for certain antibiotics, organisms, syndromes, and locations, IDC was associated with a greater antimicrobial appropriateness odds ratio (OR) of 2.4 (95% confidence interval [CI], 1.9 to 3.0). Stratification by primary service showed an OR of 2.9 (95% CI, 2.1 to 3.8) for surgical specialties and an OR of 1.6 (95% CI, 1.1 to 2.2) for medical specialties. Even with a high overall antimicrobial appropriateness, patients with IDC had greater odds of antimicrobial appropriateness than those without IDC, and this impact was greater in surgical specialties. Infectious diseases consultation can be synergistic with antimicrobial stewardship programs.

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