Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa.
Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City.
JAMA Netw Open. 2020 Feb 5;3(2):e1921048. doi: 10.1001/jamanetworkopen.2019.21048.
Staphylococcus aureus bacteremia (SAB) is common and associated with poor long-term outcomes. Previous studies have demonstrated an association between infectious diseases (ID) consultation and improved short-term (ie, within 90 days) outcomes for patients with SAB, but associations with long-term outcomes are unknown.
To investigate the association of ID consultation with long-term (ie, 5 years) postdischarge outcomes among patients with SAB.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included all patients (N = 31 002) with a first episode of SAB who were discharged alive from 116 acute care units of the nationwide Veterans Health Administration where ID consultation was offered. Data were collected from January 2003 to December 2014, with follow-up through September 30, 2018. Data analysis was conducted from February to December 2019.
Infectious diseases consultation during the index hospital stay.
The primary outcome was time to development of a composite event of all-cause mortality or recurrence of SAB within 5 years of discharge. As secondary outcomes, SAB recurrence and all-cause mortality with and without recurrence were analyzed while accounting for semicompeting risks.
The cohort included 31 002 patients (30 265 [97.6%] men; median [interquartile range] age at SAB onset, 64.0 [57.0-75.0] years). Among 31 002 patients, there were 18 794 (60.6%) deaths, 4772 (15.4%) SAB recurrences, and 20 414 (65.8%) composite events during 5 years of follow-up; 12 773 deaths (68.0%) and 2268 recurrences (47.5%) occurred more than 90 days after discharge. Approximately half of patients (15 360 [49.5%]) received ID consultation during the index hospital stay; ID consultation was associated with prolonged improvement in the composite outcome (adjusted hazard ratio at 5 years, 0.71; 95% CI, 0.68-0.74; P < .001). Infectious diseases consultation was also associated with improved outcomes when all-cause mortality without recurrence and SAB recurrence were analyzed separately (all-cause mortality without recurrence: adjusted hazard ratio at 5 years, 0.77; 95% CI, 0.74-0.81; P < .001; SAB recurrence: adjusted hazard ratio at 5 years, 0.68; 95% CI, 0.64-0.72; P < .001).
Having an ID consultation during the index hospital stay among patients with SAB was associated with improved postdischarge outcomes for at least 5 years, suggesting that contributions of ID specialists to management during acute infection may have a substantial influence on long-term outcomes. Further investigations of the association of ID consultation with outcomes after S aureus should include long-term follow-up.
金黄色葡萄球菌菌血症 (SAB) 很常见，且与不良的长期预后相关。先前的研究已经证明了感染病（ID）会诊与 SAB 患者短期（即 90 天内）预后改善之间存在关联，但与长期预后的关联尚不清楚。
调查 ID 会诊与 SAB 患者出院后 5 年长期（即 5 年）转归之间的关联。
设计、地点和参与者：本队列研究纳入了所有从全国退伍军人健康管理局的 116 个急性护理病房出院的、首次发生 SAB 且存活的患者（N=31002），在这些病房中提供 ID 会诊。数据收集于 2003 年 1 月至 2014 年 12 月，随访至 2018 年 9 月 30 日。数据分析于 2019 年 2 月至 12 月进行。
在住院期间进行 ID 会诊。
主要结局是所有原因死亡率或 SAB 复发的复合事件在出院后 5 年内发生的时间。作为次要结局，在考虑半竞争风险的情况下，分析了 SAB 复发和全因死亡率以及有无复发的情况。
该队列纳入了 31002 例患者（30265 [97.6%] 男性；SAB 发病时的中位[四分位间距]年龄，64.0 [57.0-75.0] 岁）。在 31002 例患者中，5 年随访期间有 18794 例（60.6%）死亡，4772 例（15.4%）SAB 复发，20414 例（65.8%）复合事件；12773 例（68.0%）死亡和 2268 例（47.5%）复发发生在出院后 90 天以上。大约一半的患者（15360 [49.5%]）在住院期间接受了 ID 会诊；ID 会诊与复合结局的改善相关（5 年的调整危险比，0.71；95%CI，0.68-0.74；P<0.001）。当单独分析全因死亡率无复发和 SAB 复发时，ID 会诊也与更好的结局相关（全因死亡率无复发：5 年的调整危险比，0.77；95%CI，0.74-0.81；P<0.001；SAB 复发：5 年的调整危险比，0.68；95%CI，0.64-0.72；P<0.001）。
SAB 患者在住院期间进行 ID 会诊与至少 5 年的出院后转归改善相关，这表明 ID 专家在急性感染期间对管理的贡献可能对长期预后有重大影响。进一步调查 ID 会诊与金黄色葡萄球菌感染后结局的相关性，应包括长期随访。
