Scholars@Duke publication: Outcome of Staphylococcus aureus Bacteremia according to compliance with infectious diseases specialist recommendations: experience with 253 patients

Outcome of Staphylococcus aureus Bacteremia according to compliance with infectious diseases specialist recommendations: experience with 253 patients

Publication , Journal Article

Fowler, V; Sexton, D; Kong, L; Gopal, A; Gottlieb, G; Scott McClelland, R; Ralph Corey, G

Published in: Clinical Infectious Diseases

December 1, 1997

The impact of infectious disease specialist involvement on the clinical outcome of hospitalized patients has been inadequately studied. To determine whether recommendations of infectious disease specialists affect the clinical outcome of hospitalized patients with Staphylococcus aureus bacteremia (SAB), we identified, evaluated, and examined all hospitalized patients with SAB at our institution during a 25 month period, offered our management recommendations to the patients' physicians, and then assessed the clinical outcome both of patients in whom our consultative advice was followed and those in whom our advice was not heeded. Two hundred fifty-three patients were enrolled in the study and followed for 12 weeks after the first positive blood culture. Our management advice was followed in 116 patients (46%) and completely or partially ignored in 137 patients (54%). Reasons for failure to follow the recommendations of the infectious disease team included failure to obtain echocardiography(107 patients), failure to remove an intravascular focus of infection (25 patients), failure to obtain surveillance blood cultures (2 patients), or treatment for longer than our recommended duration of therapy (3 patients). The clinical characteristics of the patients in whom recommendations were followed were similar to those patients in whom recommendations were not followed. Patients in whom our recommendations were followed were less likely to relapse with S. aureus infection (p=0.01), despite significantly more metastatic infections at the outset of therapy. These findings suggest that infectious disease specialist involvement can improve the clinical outcome of patients with S. aureus bacteremia.