Impact of routine infectious diseases service consultation on the evaluation, management, and outcomes of Staphylococcus aureus bacteremia
Impact of routine infectious diseases service consultation on the evaluation, management, and outcomes of Staphylococcus aureus bacteremia
复制标题
DOI：
10.1086/529190
复制
发表时间：
2008-04-01
影响因子：
11.8
通讯作者：
Burman, William J.
中科院分区：
文献类型：
--
作者：
Jenkins, Timothy C.;Price, Connie S.;Burman, William J.
背景金黄色葡萄球菌菌血症导致相当高的发病率和死亡率，需要改善这种疾病的管理和结局的策略。如果感染了沙门氏菌，应向传染病专家进行常规咨询。2005年5月，我院强制规定金黄色葡萄球菌菌血症。我们比较了政策变化前后的评估、管理和病例结局。所有比较都是按时期进行的（即，之前或之后启动的政策，例行协商）。在实施常规会诊前一年和实施后一年，分别有134例和100例沙门氏菌感染。金黄色葡萄球菌菌血症。咨询率从政策改变前的53%上升到政策改变后的90%（P <0.001）。超声心动图（57% vs. 73%; P = 0.01）和放射学检查（81% vs. 91%; P = 0.04）在常规咨询期间更频繁地使用，感染性心内膜炎或转移性感染的诊断更频繁（33% vs. 46%; P = 0.04）。所有4种标准治疗（清除血管内感染病灶，获得随访血培养样本，可能时使用肠外β-内酰胺治疗，以及对复杂感染进行≥ 28天的治疗）与常规咨询的依从性更高（40% vs. 74%; P = 0.001）。治疗失败（微生物学失败、复发菌血症、晚期转移性感染或死亡）在干预年发生率较低（17% vs. 12%），但差异无统计学意义（P = 0.27）。对感染沙门氏菌的患者，应定期咨询传染病专家。金黄色葡萄球菌菌血症导致更详细的评估，更频繁地检测心内膜炎和转移性感染，并提高了对护理标准的依从性。
Background. Staphylococcus aureus bacteremia causes considerable morbidity and mortality, and strategies to improve management and outcomes of this disease are needed.Methods. Routine consultation with an infectious diseases specialist for cases of S. aureus bacteremia was mandated at our institution in May 2005. We compared the evaluation, management, and outcomes of cases before and after this policy change. All comparisons are by period (i.e., before or after initiation of the policy of routine consultation).Results. In the year before and the year after after the implementation of routine consultation, 134 and 100 cases of S. aureus bacteremia, respectively, were evaluated. Consultation rates increased from 53% of cases before to 90% of cases after the policy change (P < .001). Echocardiography (57% vs. 73%; P = .01) and radiographic studies (81% vs. 91%; P = .04) were used more frequently during the period of routine consultation, and infective endocarditis or metastatic infections were diagnosed more frequently (33% vs. 46%; P = .04). All 4 standards of care (removal of intravascular foci of infection, obtaining follow-up blood culture samples, use of parenteral beta-lactam therapy when possible, and administration of >= 28 days of therapy for complicated infections) were adhered to more frequently with routine consultation (40% vs. 74%; P = .001). Treatment failure (microbiological failure, recurrent bacteremia, late metastatic infection, or death) occurred less often during the intervention year (17% vs. 12%), but this difference was not statistically significant (P = .27).Conclusions. A policy of routine consultation with an infectious diseases specialist for patients with S. aureus bacteremia resulted in more-detailed evaluation, more-frequent detection of endocarditis and metastatic infection, and improved adherence to standards of care.