Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Center for Access & Delivery Research & Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA.
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Center for Access & Delivery Research & Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA.
Clin Microbiol Infect. 2023 Aug;29(8):1039-1044. doi: 10.1016/j.cmi.2023.03.009. Epub 2023 Mar 12.
Infectious disease consultation (IDC) has been associated with improved outcomes in several infections, but the benefit of IDC among patients with enterococcal bacteraemia has not been fully evaluated.
We performed a 1:1 propensity score-matched retrospective cohort study evaluating all patients with enterococcal bacteraemia at 121 Veterans Health Administration acute-care hospitals from 2011 to 2020. The primary outcome was 30-day mortality. We performed conditional logistic regression to calculate the OR to determine the independent association of IDC and 30-day mortality adjusted for vancomycin susceptibility and the primary source of bacteraemia.
A total of 12,666 patients with enterococcal bacteraemia were included; 8400 (63.3%) had IDC, and 4266 (36.7%) did not have IDC. Two thousand nine hundred seventy-two patients in each group were included after propensity score matching. Conditional logistic regression revealed that IDC was associated with a significantly lower 30-day mortality rate compared with patients without IDC (OR = 0.56; 95% CI, 0.50-0.64). The association of IDC was observed irrespective of vancomycin susceptibility, and when the primary source of bacteraemia was a urinary tract infection, or from an unknown primary source. IDC was also associated with higher appropriate antibiotic use, blood culture clearance documentation, and the use of echocardiography.
Our study suggests that IDC was associated with improved care processes and 30-day mortality rates among patients with enterococcal bacteraemia. IDC should be considered for patients with enterococcal bacteraemia.
传染病咨询（IDC）已被证明可改善多种感染的预后，但 IDC 对肠球菌菌血症患者的益处尚未得到充分评估。
我们进行了一项 1:1 倾向评分匹配的回顾性队列研究，评估了 2011 年至 2020 年期间在 121 家退伍军人事务部急性护理医院的所有肠球菌菌血症患者。主要结局为 30 天死亡率。我们进行了条件逻辑回归分析，以计算 OR，以确定 IDC 与 30 天死亡率之间的独立关联，调整了万古霉素敏感性和菌血症的主要来源。
共纳入 12666 例肠球菌菌血症患者；8400 例（63.3%）有 IDC，4266 例（36.7%）无 IDC。在倾向评分匹配后，每组纳入 2972 例患者。条件逻辑回归显示，与无 IDC 的患者相比，IDC 与显著较低的 30 天死亡率相关（OR=0.56；95%CI，0.50-0.64）。无论万古霉素敏感性如何，以及菌血症的主要来源是尿路感染还是未知的原发性感染，ID C 的相关性均存在。ID C 还与更高的适当抗生素使用、血培养清除记录以及超声心动图的使用相关。
我们的研究表明，IDC 与肠球菌菌血症患者的治疗过程和 30 天死亡率的改善相关。对于肠球菌菌血症患者，应考虑进行 IDC。
