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Impact of Infectious Disease Consultation on Clinical Management and Outcome of Patients with Bloodstream Infection: a Retrospective Cohort Study.

ABSTRACT: The impact of consultation by infectious diseases (ID) physicians on management and outcomes of patients has not been determined in China. We assembled a retrospective cohort of 995 consecutive adult cases with bloodstream infections (BSI) in a major teaching hospital in China. Survival analysis was performed with Cox regression and the Kaplan-Meier curves. Among the 995 patients with BSI, 421 (42.3%) received consultation by ID physicians and 574 (57.7%) did not. ID consultation led to a significant lower hazard of death (hazard ratio [HR], 0.575; P < 0.05) and more appropriate antimicrobial use (95.0% vs 67.6%, P < 0.05). ID consultation was a protective factor among patients with BSI due to Gram-positive (HR, 0.551; P < 0.05) or Gram-negative (HR, 0.331; P < 0.05) bacteria. Multiple ID consultation was a protective factor (HR, 0.51; P < 0.05), while single consultation was not. In conclusion, ID consultation led to significant lower risk for patients with BSI and improved management. Multiple rather than single ID consultations reduced the hazard of death.

SUBMITTER: Tang G

PROVIDER: S-EPMC5635120 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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Impact of Infectious Disease Consultation on Clinical Management and Outcome of Patients with Bloodstream Infection: a Retrospective Cohort Study.

Tang Guangmin G Huang Liang L Zong Zhiyong Z

Scientific reports 20171010 1

The impact of consultation by infectious diseases (ID) physicians on management and outcomes of patients has not been determined in China. We assembled a retrospective cohort of 995 consecutive adult cases with bloodstream infections (BSI) in a major teaching hospital in China. Survival analysis was performed with Cox regression and the Kaplan-Meier curves. Among the 995 patients with BSI, 421 (42.3%) received consultation by ID physicians and 574 (57.7%) did not. ID consultation led to a signif ...[more]

PMID: 29018215

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Project description:BackgroundCandida bloodstream infection is associated with high mortality. Infectious disease consultation improves outcomes in several infections, including Staphylococcus aureus and cryptococcosis, as well as multidrug-resistant organisms. We aimed to examine the association between infectious disease consultation and differences in management with mortality in candida bloodstream infections.MethodsIn this retrospective, single-centre cohort study, we reviewed the medical charts of all patients admitted to Barnes-Jewish Hospital (St Louis, MO, USA), a tertiary referral centre, aged 18 years or older with candida bloodstream infection from 2002 to 2015. We collected data for demographics, comorbidities, predisposing factors, all-cause mortality, antifungal use, central-line removal, and ophthalmological and echocardiographic evaluation to assess 90-day all-cause mortality between individuals with and without an infectious disease consultation. For the survival analysis we used Cox proportional hazards model with inverse weighting by propensity score to assess the effects of infectious disease consultation on mortality and differences in management.FindingsBetween Jan 1, 2002, and Dec 31, 2015, of 1794 patients assessed for eligibility, we analysed 1691 patients with candida bloodstream infection; 776 (45·9%) who had an infectious disease consultation and 915 (54·1%) who did not have an infectious disease consultation. All 1691 patients were included in the analysis. None were missing data. Most underlying comorbidities were evenly distributed between groups. 90-day mortality was lower in the infectious disease consultation group than in patients who did not receive an infectious disease consultation (29% [222/776] vs 51% [468/915]; p<0·0001). In the model with inverse weighting by the propensity score, infectious disease consultation was associated with a hazard ratio of 0·81 (95% CI 0·73-0·91; p<0·0001) for mortality. In the consultation group, median duration of antifungal therapy was longer (18 [IQR 14-35] vs 14 [6-20] days; p<0·0001) and central-line removal (587 [76%] of 776 vs 538 [59%] of 915; p<0·0001), echocardiography use (442 [57%] of 776 vs 305 [33%] of 915; p<0·0001), and ophthalmological examination (412 [53%] of 776 vs 160 [17%] of 915; p<0·0001) were more frequently done. Fewer patients in the infectious disease consultation group were not treated (13 [2%] of 776 vs 128 [14%] of 915; p<0·0001).InterpretationPatients with candida bloodstream infection receiving an infectious disease consultation have lower mortality. This finding might be attributable to these individuals receiving a higher number of non-pharmacological, evidence-based interventions and lower amounts of non-treatment. These data suggest that an infectious disease consultation should be an integral part of clinical care of patients with candida bloodstream infection.FundingAstellas Global Development Pharma, Washington University Institute of Clinical and Translational Sciences, and the Agency for Healthcare Research and Quality.

Dataset Information

Impact of Infectious Disease Consultation on Clinical Management and Outcome of Patients with Bloodstream Infection: a Retrospective Cohort Study.

Publications

Impact of Infectious Disease Consultation on Clinical Management and Outcome of Patients with Bloodstream Infection: a Retrospective Cohort Study.

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