Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine Royal Perth Hospital, Wellington Street, Perth, 6000, Western Australia, Australia.
Eur J Clin Microbiol Infect Dis. 2012 Sep;31(9):2421-8. doi: 10.1007/s10096-012-1585-y. Epub 2012 Mar 3.
To determine the impact of infectious diseases consultation (IDC) in Staphylococcus aureus bacteraemia. All MRSA bacteraemia and a random subset of MSSA bacteraemia were retrospectively analysed. Out of 599 SAB episodes, 162 (27%) were followed by an IDC. Patients with IDC were younger and more frequently intravenous drug users, but fewer resided in a long-term care facility or were indigenous. Hospital length of stay was longer (29.5 vs 17 days, p < 0.001), and endocarditis (19.1% vs 7.3%, p < 0.001) and metastatic seeding (22.2% vs 10.1%, p < 0.001) were more frequent in the IDC group; however, SAPS II scores were lower in the IDC group (27 vs 37, p < 0.001). ICU admission rates in the two groups were similar. The isolate tested susceptible to empirical therapy more frequently in the IDC group (88.9% vs 78.0%, p = 0.003). Seven-day (3.1 vs 16.5%), 30-day (8.0% vs 27.0%) and 1-year mortality (22.2% vs 44.9%) were all lower in the IDC group (all p < 0.001). Multivariate analysis showed that effective initial therapy was the only variable associated with the protective effect of IDC. In patients with SAB, all-cause mortality was significantly lower in patients who had an IDC, because of the higher proportion of patients receiving effective initial antibiotics.
为了确定传染病咨询(IDC)对金黄色葡萄球菌菌血症的影响。回顾性分析了所有耐甲氧西林金黄色葡萄球菌菌血症(MRSA)和随机选择的部分甲氧西林敏感金黄色葡萄球菌菌血症(MSSA)。在 599 例 SAB 发作中,有 162 例(27%)随后进行了 IDC。接受 IDC 的患者更年轻,且更常为静脉药物使用者,但居住在长期护理机构或土著居民的比例较低。住院时间更长(29.5 天与 17 天,p<0.001),ID C 组的心内膜炎(19.1%与 7.3%,p<0.001)和转移性播散(22.2%与 10.1%,p<0.001)更为常见,但 IDC 组 SAPS II 评分较低(27 分与 37 分,p<0.001)。两组 ICU 入院率相似。ID C 组的分离株对经验性治疗更敏感(88.9%与 78.0%,p=0.003)。7 天(3.1%与 16.5%)、30 天(8.0%与 27.0%)和 1 年死亡率(22.2%与 44.9%)均在 ID C 组较低(均 p<0.001)。多变量分析表明,有效初始治疗是 ID C 保护作用的唯一相关变量。在 SAB 患者中,ID C 患者的全因死亡率明显较低,因为接受有效初始抗生素治疗的患者比例更高。