June 24, 2019
2 min read

Antimicrobial stewardship teams, ID consults reduce S. aureus bacteremia

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Involvement of the antimicrobial stewardship team and infectious disease consultation are associated with reduced mortality from Staphylococcus aureus bacteremia, or SAB, according to study findings.

Moreover, researchers found that the addition of antimicrobial stewardship team involvement reduced mortality rates “beyond the benefits” of ID consultation alone.

Writing in Infection Control & Hospital Epidemiology, Jacqueline E. Sherbuk, MD, and colleagues from the Yale School of Medicine and Yale New Haven Hospital, noted that ID consultation (IDC) has been shown to improve adherence to management guidelines and reduce mortality from SAB, and is recommended for cases of bacteremia in MRSA guidelines, whereas having an antimicrobial stewardship team (AST) has been associated with reductions in health care expenditures and improved use of antimicrobials.

The analysis included 229 adult hospitalized patients aged 18 years or older who were admitted in 2015 with an S. aureus-positive blood culture.

“The AST/IDC group included patients evaluated by IDC and/or the AST,” Sherbuk and colleagues wrote. “The primary outcome was 30-day mortality from day 0, when the sample for blood culture was drawn. Relapse and reinfection were evaluated as secondary outcomes.”

According to the study, in 76% of patients, input was received from AST/IDC, including 17% who were initially identified and evaluated by AST.

Of the patients in the AST/IDC group, 52% had health care-associated infections (HAIs), 33% had bone and joint infections, 11% had endocarditis and 7% had metastatic infections. Comparatively, 62% of patients who did not receive AST/IDC had HAIs, 9% had bone and joint infections, and none had endocarditis or metastatic infections. Moreover, rates of MRSA, sepsis and ICU admissions were similar between the two groups, and length of stay and readmission rates were comparable. Relapse and reinfection were reported for 5% of patients or less in both groups, Sherbuk and colleagues reported.

They found that the AST/IDC group had a lower 30-day mortality rate compared with the non-AST/IDC group (OR = 0.4; P = .02). Modeling showed that including IDC only in place of AST/IDC did not show a statistically significant effect.

“Antimicrobial stewardship programs are an integral part of the health care system. Our findings demonstrate the value AST can add in improving care delivery and patient outcomes when thoughtfully incorporated into patient care,” Sherbuk told Infectious Disease News. “The optimal approach to SAB management may involve both antimicrobial stewardship programs and ID physicians, and may differ between institutions based on the resources and expertise available.” – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.