Forsblom Erik, Frilander Hanna, Ruotsalainen Eeva, Järvinen Asko
Division of Infectious Diseases, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Open Forum Infect Dis. 2019 Nov 19;6(12):ofz495. doi: 10.1093/ofid/ofz495. eCollection 2019 Dec.
Formal infectious diseases specialist (IDS) consultation has been shown to improve short-term outcomes in bacteremia (SAB), but its effect on long-term outcomes lacks evaluation.
This retrospective study followed 367 methicillin-sensitive (MS) SAB patients for 10 years. The impact of formal IDS consultation on risk for new bacteremia and outcome during long-term follow-up was evaluated. Patients who died within 90 days were excluded to avoid interference from early deceased patients.
Three hundred four (83%) patients had formal IDS consultation, whereas 63 (17%) received informal or no IDS consultation. Formal consultation, compared with informal or lack of consultation, was associated with a reduced risk of new bacteremia caused by any pathogen within 1 year (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.18-0.84; = .014; 8% vs 17%) and within 3 years (OR, 0.39; 95% CI, 0.19-0.80; = .010; 9% vs 21%), whereas a trend toward lower risk was observed within 10 years (OR, 0.56; 95% CI, 0.29-1.08; = .079; 16% vs 25%). Formal consultation, compared with informal or lack of consultation, improved outcomes at 1 year (OR, 0.16; 95% CI, 0.06-0.44; < .001; 3% vs 14%), at 3 years (OR, 0.19; 95% CI, 0.09-0.42; < .001; 5% vs 22%), and at 10 years (OR, 0.43; 95% CI, 0.24-0.74; = .002; 27% vs 46%). Considering all prognostic parameters, formal consultation improved outcomes (HR, 0.42; 95% CI, 0.27-0.65; < .001) and lowered risk for any new bacteremia (OR, 0.45; 95% CI, 0.23-0.88; = .02) during 10 years of follow-up.
MS-SAB management by formal IDS consultation, compared with informal or lack of IDS consultation, reduces risk for new bacteremia episodes and improves long-term prognosis up to 10 years.
正式的感染性疾病专科医生（IDS）会诊已被证明可改善菌血症（SAB）的短期预后，但其对长期预后的影响尚缺乏评估。
这项回顾性研究对367例甲氧西林敏感（MS）的SAB患者进行了为期10年的随访。评估了正式的IDS会诊对长期随访期间新发菌血症风险和预后的影响。排除90天内死亡的患者以避免早期死亡患者的干扰。
304例（83%）患者接受了正式的IDS会诊，而63例（17%）接受了非正式或未接受IDS会诊。与非正式或未会诊相比，正式会诊与1年内（优势比[OR]，0.39；95%置信区间[CI]，0.18 - 0.84；P = 0.014；8%对17%）和3年内（OR，0.39；95% CI，0.19 - 0.80；P = 0.010；9%对21%）由任何病原体引起的新发菌血症风险降低相关，而在10年内观察到风险有降低趋势（OR，0.56；95% CI，0.29 - 1.08；P = 0.079；16%对25%）。与非正式或未会诊相比，正式会诊在1年时（OR，0.16；95% CI，0.06 - 0.44；P < 0.001；3%对14%）、3年时（OR，0.19；95% CI，0.09 - 0.42；P < 0.001；5%对22%）和10年时（OR，0.43；95% CI，0.24 - 0.74；P = 0.002；27%对46%）改善了预后。考虑所有预后参数，正式会诊在10年随访期间改善了预后（风险比[HR]，0.42；95% CI，0.27 - 0.65；P < 0.001）并降低了任何新发菌血症的风险（OR，0.45；95% CI，0.23 - 0.88；P = 0.02）。
与非正式或未进行IDS会诊相比，通过正式的IDS会诊管理MS - SAB可降低新发菌血症发作的风险，并改善长达10年的长期预后。
