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The association of infectious diseases consultation and 30-day mortality rates among veterans with enterococcal bacteremia: a propensity-score matched retrospective cohort study
Journal article   Peer reviewed

The association of infectious diseases consultation and 30-day mortality rates among veterans with enterococcal bacteremia: a propensity-score matched retrospective cohort study

Joseph Tholany, Hiroyuki Suzuki, Daniel J Livorsi, Eli N Perencevich and Michihiko Goto
Clinical microbiology and infection, Vol.29(8), pp.1039-1044
08/2023
DOI: 10.1016/j.cmi.2023.03.009
PMID: 36914070

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Abstract

Infectious disease consultation (IDC) has been associated with improved outcomes in several infections, but the benefit of IDC among patients with enterococcal bacteremia has not been fully evaluated. We performed a 1:1 propensity-score matched retrospective cohort study evaluating all patients with enterococcal bacteremia at 121 Veterans Health Administration acute-care hospitals from 2011 to 2020. The primary outcome was 30-day mortality. We performed conditional logistic regression to calculate the odds ratio (OR) to determine the independent association of IDC and 30-day mortality adjusted for vancomycin susceptibility and the primary source of bacteremia. 12,666 patients with enterococcal bacteremia were included. 8,400 (63.3%) had IDC and 4,266 (36.7%) did not have IDC. 2,972 patients in each group were included after propensity-score matching. Conditional logistic regression revealed that IDC was associated with a significantly lower 30-day mortality rate compared to patients without IDC (OR=0.56; 95% CI, 0.50-0.64). The association of IDC was observed irrespective of vancomycin susceptibility, and when the primary source of bacteremia was a urinary tract infection, or from an unknown primary source. IDC was also associated with higher appropriate antibiotic use, blood culture clearance documentation, and the use of echocardiography. Our study suggests that IDC was associated with improved care processes and 30-day mortality rates among patients with enterococcal bacteremia. IDC should be considered for patients with enterococcal bacteremia.
Enterococcus enterococcal bacteremia infectious diseases consultation

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