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Long-term Impacts of Infectious Diseases Consultation on Post-Discharge Outcomes for Patients with Staphylococcus aureus Bacteremia: a Cohort Analysis in Veterans Health Administration
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Long-term Impacts of Infectious Diseases Consultation on Post-Discharge Outcomes for Patients with Staphylococcus aureus Bacteremia: a Cohort Analysis in Veterans Health Administration

Michihiko Goto, Marin Schweizer, Daniel Livorsi, Eli Perencevich, Kelly Richardson, Brice Beck, Bruce Alexander and Michael Ohl
Open forum infectious diseases, Vol.4(suppl_1), pp.S554-S555
2017
DOI: 10.1093/ofid/ofx163.1442
url
https://doi.org/10.1093/ofid/ofx163.1442View
Published (Version of record) Open Access

Abstract

Abstract Background Staphylococcus aureus bacteremia (SAB) is common and associated with significant morbidity and mortality. Previous studies showed infectious diseases (ID) consultation had short-term beneficial effects on mortality and relapse among patients with SAB. However, less is known about longer-term effects of ID consultation on SAB outcomes. We aimed to assess the impacts of inpatient ID consultation on mortality and bacteremia relapse within 180 days of discharge among patients hospitalized with SAB. Methods We conducted a retrospective cohort study of all patients discharged from acute care units of 129 Veterans Health Administration (VHA) hospitals after receiving care for SAB, between 2003 and 2014. Demographics, comorbidities, microbiology, and consultation data were extracted from electronic medical records. Mortality data were obtained from VHA fs Vital Status File, which includes deaths occurring outside VHA. The exposure variable was ID consultation during admission for the first episode of SAB and the primary endpoint was a composite outcome of all-cause mortality or relapse of SAB within 180 days after discharge. Multivariable Cox regression models with time-dependent covariates were used to assess the effects of ID consultation. Results The cohort included 31131 patients discharged after first episodes of SAB. 49.4% received ID consultation during the acute care admission. Most (21206, 68.1%) survived for 180 days without SAB relapse, 7887 (25.3%) died, and 3078 (9.9%) had SAB relapse. Patients with ID consultation had significantly higher relapse-free survival rates (Figure 1), particularly within 90 days after discharge. ID consultation was associated with relapse-free survival after adjusting for patient characteristics using multivariable Cox regression (HR at 30 days: 0.638; HR at 90 days: 0.847; both P < 0.001). Conclusion ID consultation for SAB during hospitalization was associated with significantly higher relapse-free survival rates after hospital discharge. Possible explanations are more appropriate management during admission, more effective antibiotic therapy, and better follow-up care. The potentially prolonged benefits of ID consultation on SAB should be evaluated in future studies. Disclosures M. Schweizer, B Braun: Speaker at a course, Travel reimbursement to teach course

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