A Comparison of Outcomes With and Without Infectious Diseases Consultation for Enterococcal Bacteraemia in a Multicenter Healthcare System

• Published in: International journal of antimicrobial agents Vol. 60; no. 5-6; p. 106665
• Main Authors: Shephard, Emily A., Mondy, Kristin, Reveles, Kelly R., Jaso, Theresa, Rose, Dusten T.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.11.2022
• Subjects: Adult; Anti-Bacterial Agents - therapeutic use; Bacteraemia; Bacteremia - diagnosis; Bacteremia - drug therapy; Communicable Diseases - drug therapy; Delivery of Health Care; Enterococci; Gram-Positive Bacterial Infections - diagnosis; Gram-Positive Bacterial Infections - drug therapy; Humans; Infectious diseases; Retrospective Studies; Treatment Outcome; Enterococci; Bacteraemia; Infectious diseases
• ISSN: 0924-8579; 1872-7913
• DOI: 10.1016/j.ijantimicag.2022.106665

•In enterococcal bacteraemia, clinical failure did not differ with and without infectious diseases consultation (IDC).•IDC improves adherence to treatment bundles.•IDC may have antimicrobial stewardship benefits. It is unknown whether infectious diseases consultation improves outcomes for enterococcal bacteraemia in a multicentre healthcare system. This retrospective multicentre observational cohort study included 250 adult patients with enterococcal bacteraemia between July 2016 and December 2020. The primary endpoint was a composite of clinical failure, including persistent bacteraemia, persistent fever, and in-hospital mortality. Secondary endpoints included adherence to a treatment bundle (appropriate empiric and definitive antibiotics, appropriate planned treatment duration, obtaining repeat blood cultures and an echocardiogram). Clinical failure occurred in 35 of 155 patients (22.6%) with an infectious diseases consultation and 16 of 95 patients (16.8%) without an infectious diseases consultation (P = 0.274). Multivariate analysis identified vasopressors as the only independent predictor of the primary outcome. Infectious diseases consultation resulted in higher adherence to a treatment bundle, including echocardiogram (75.5% vs. 34.7%; P < 0.0001), repeat blood cultures (85.2% vs. 68.4%; P = 0.002), appropriate definitive antibiotics (70.5% vs. 91.6%; P < 0.0001) and appropriate planned durations of therapy (81.1% vs. 94.2%; P = 0.001). More patients in the consult group were treated with ampicillin (47.1% vs. 22.1%; P < 0.0001) and fewer were treated with vancomycin (17.4% vs. 24.2%; P = 0.068). Despite finding no difference in clinical failure between groups, this study highlights important benefits of infectious diseases consultation in enterococcal bacteraemia.