Article
Staphylococcus aureus Bacteremia – a challenge in surgery – Impact of Infectious disease consultation on patient’s outcome and survival
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Published: | March 21, 2014 |
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Introduction: Staphylococcus aureus Bacteremia (SAB) is associated with a high mortality. Strategies for optimal management include the removal of intravascular foreign bodies, adequate treatment (i.e. antistaphylococcal betalactam for methicillin-susceptible Staphylococcus aureus, follow-up blood cultures, performance of an echocardiogram and adequate treatment duration). It is well known that these standards of care are essential for the outcome of patients with SAB. It has also been suggested, that combination treatment for indwelling foreign bodies and for complicated SAB might be of benefit. The aim of our study was to determine the impact of infectious disease (ID) consultation on these five standards of care and mortality.
Material and methods: We analysed data from our prospective SAB database. All episodes of SAB from the department of surgery and internal medicine over 30 months before and after implementation of routine ID consultation for SAB were used. The standards of care met with and without infectious disease consultation were compared. Routine ID consultation was implemented after 10 months.
Results: We analysed 138 patients in the study period. Nine patients were excluded, because they died within three days after the blood culture was drawn. Infectious disease consultation was performed in 90 (79,7%) of the remaining 129 patients. There was no significant difference between the groups concerning sex, age, severity of illness score, Charlson comorbity index, or MRSA rate. The number of standards of care met was significantly higher and mortality lower (p=0.028) in patients receiving routine ID consultation. All standards of care met could significantly be increased, two additional standards were also significantly more often achieved.
Conclusion: Routine Infectious diseases consultation improved the adherence to management guidelines of SAB. Mortality decreased with routine infectious disease consultation.