Formal infectious diseases specialist consultation improves long-term outcome of methicillin-sensitive Staphylococcus aureus bacteremia

Abstract

Abstract Background Formal infectious diseases specialist (IDS) consultation has been shown to improve short-term outcome of Staphylococcus aureus bacteremia (SAB) but its effect on long-term outcome lacks evaluation. Methods Retrospective study of 367 methicillin-sensitive (MS) SAB patients followed for 10 years. The impact of formal IDS consultation on risk for new bacteremia and outcome during long-term follow-up were evaluated. Patients who died within 90 days were excluded to avoid interference from early deceased patients. Results 304 (83%) patients had formal IDS consultation whereas 63 (17%) received informal or no IDS consultation. Formal consultation, compared to informal or lack of consultation, associated to a reduced risk for a new bacteremia caused by any pathogen within 1-year (OR, 0.39; 95% CI, .18-.84; p=.014; 8% vs. 17%), and within 3-years (OR, 0.39; 95% CI, .19-.80; p=.010; 9% vs. 21%) whereas a trend towards a lower risk was observed within 10-years (OR, 0.56; 95% CI, .29-1.08; p=.079; 16% vs. 25%). Formal consultation, compared to informal or lack of consultation, improved outcome at 1-year (OR, 0.16; 95% CI, .06-.44; p<0.001; 3% vs. 14%), at 3-years (OR, 0.19; 95% CI, .09-.42; p<.001; 5% vs. 22%) and at 10-years (OR, 0.43; 95% CI, .24-.74; p=.002; 27% vs. 46%). Considering all prognostic parameters formal consultation improved outcome (HR, 0.42; 95% CI, .27-.65, p<.001) and lowered risk for any new bacteremia (OR, 0.45; 95% CI, .23-.88, p=.02) during 10-years follow-up. Conclusion MS-SAB management by formal IDS consultation, compared to informal or lack of IDS consultation, reduces risk for any new bacteremia episodes and improves long-term prognosis up to ten years.