Cobussen M, van Tiel F H, Oude Lashof A M L
Department of Medical Microbiology, Maastricht UMC+, Maastricht, the Netherlands.
Neth J Med. 2018 Sep;76(7):322-329.
Staphylococcus aureus bacteraemia is associated with a high mortality rate. Previously it has been shown that consultation by an internist-infectious diseases specialist (IDS) improves the outcome of patients. In this study, we evaluated the differences in management and outcome between patients with, and those without IDS consultation.
All adult patients with a positive blood culture for S. aureus from January 2010 to December 2013 were retrospectively identified with the electronic registration system of our Laboratory for Medical Microbiology. Clinical and microbiological characteristics were retrieved from the electronic patient files, as well as information on bedside consultation by an IDS.
A total of 234 patients with S. aureus bacteraemia were included in the study, of whom 77.8% were consulted by an IDS. Management of patients with IDS consultation was more often according to guidelines than was the case without consultation by an IDS; follow up blood cultures were taken more often (97.8% vs. 80.8%, p < 0.001), patients received echocardiography more often (70.9% vs. 50.0%, p = 0.007), and they were more often treated adequately (86.6% vs. 59.2%, p < 0.001). The detection rate of complications in the IDS group was higher (59.3% vs. 32.7%, p = 0.001) and 30-day mortality rate was lower (12.1% vs. 23.1%, p = 0.04). This was confirmed by multivariate analysis.
In patients with a S. aureus bacteraemia, bedside consultation by an IDS results in better adherence to diagnostic and treatment guidelines, with higher detection of complications and a higher survival rate.
金黄色葡萄球菌菌血症与高死亡率相关。此前已有研究表明，由内科传染病专家（IDS）会诊可改善患者的治疗结果。在本研究中，我们评估了接受IDS会诊和未接受IDS会诊的患者在治疗管理及治疗结果上的差异。
通过我们医学微生物实验室的电子登记系统，对2010年1月至2013年12月期间所有血培养金黄色葡萄球菌呈阳性的成年患者进行回顾性识别。从电子患者档案中获取临床和微生物学特征，以及关于IDS床边会诊的信息。
本研究共纳入234例金黄色葡萄球菌菌血症患者，其中77.8%接受了IDS会诊。与未接受IDS会诊的患者相比，接受IDS会诊的患者治疗管理更常遵循指南；更常进行后续血培养（97.8%对80.8%，p<0.001），更常接受超声心动图检查（70.9%对50.0%，p = 0.007），且更常接受充分治疗（86.6%对59.2%，p<0.001）。IDS组并发症的检出率更高（59.3%对32.7%，p = 0.001），30天死亡率更低（12.1%对23.1%，p = 0.04）。多因素分析证实了这一点。
对于金黄色葡萄球菌菌血症患者，IDS床边会诊可使诊断和治疗指南的依从性更好，并发症检出率更高，生存率更高。
