September 16, 2023
2 min read
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Disclosures:
The authors report no relevant financial disclosures.
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Key takeaways:
- Patients with gram-negative BSI who received an infectious disease consultation had a lower risk for 30- and 90-day mortality.
- Decreased mortality did not cause an increase in readmission or recurrence.
Patients with gram-negative bloodstream infections had a decreased risk for 30-day mortality if they received an infectious disease consultation as part of their care, researchers reported.
“Jacqueline T. Bork, MD, and I participated in a national collaborative committed to optimizing patient outcomes through improved antibiotic prescribing practices. Given limited data regarding optimal management for patients with gram-negative bloodstream infections (GN-BSI), The Antibiotic Stewardship Implementation Collaborative was formed in 2019 to identify and address knowledge gaps in management,” Stephanie Shulder, PharmD, BCIDP, infectious diseases clinical pharmacy specialist at the University of Rochester Medical Center’s Strong Memorial Hospital, told Healio.
Receiving an infectious disease consultation improved outcomes for patients with gram-negative bloodstream infections including 30- and 90-day mortality, readmission and recurrence. Image: Adobe Stock.
“There are data supporting the benefit of infectious diseases (ID) consultation with other organisms, including Staphylococcus aureus and Candida, but there are limited and conflicting data for GN-BSI. We were interested in evaluating the impact of ID consultation on patient outcomes in GN-BSI,” Shulder said.
To do so, the researchers conducted a large, multicenter retrospective observational cohort study that included 24 hospitals in the U.S. with active antimicrobial stewardship programs with physician and pharmacy leadership, and assessed all adult patients admitted between January 2019 to December 2019 with GN-BSI.
The primary study outcome was 30-day mortality, although secondary outcomes included 30-day readmission due to the index infection, 30-day bacteremia recurrence and 90-day mortality. Outcomes were then compared between patients who had received ID consultation and those who did not.
In total, there were 4,861 GN-BSI episodes, of which 2,814 (58%) had ID consultation, although 155 (3.1%) episodes were excluded due to death within 48 hours. Of all the GN-BSI episodes analyzed, 681 (14%) resulted in 30-day mortality — 12% among patients who had received ID consultation and 17% who did not.
Patients who received an ID consultation had a significantly lower risk of 30-day mortality after propensity score weighting (HR = 0.6; 95% CI, 0.47-0.77), as well as at 90-days (HR = 0.7; 95% CI, 0.57-0.86), according to the study.
The study also showed that there were 869 (18%) GN-BSI episodes that resulted in 30-day readmission (20% in patients who had ID consultation vs. 15% who did not) and 85 (1.7%) that resulted in 30-day recurrent bacteremia (2.1% vs. 1.3%).
After propensity score weighting though, the team found there was no difference in 30-day readmission for patients with or without an ID consultation (HR = 1.09; 95% CI, 0.77-1.54) or 30-day recurrent bacteremia (HR = 1.33; 95% CI, 0.70-2.52).
“There can be significant benefit in obtaining ID consultation in patients with gram-negative bloodstream infections to guide overall management,” Shulder said. “We identified both decreased 30- and 90-day mortality with no difference in readmission or recurrent infection. This is the largest study to date evaluating the role of ID consultation that covers a wide array of gram-negative organisms and susceptibility profiles.”
She concluded, “Our study adds to the limited literature while future studies can help determine which populations may experience the most benefit with limited ID resources.”
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