The Value of Antimicrobial Stewardship Team (AST) in Conjunction with Infectious Diseases Consult in Reducing the 30-day Mortality of Patients with Staphylococcus aureus Bacteremia in a Single Academic Medical Center

Abstract

Background Staphylococcus aureus bacteremia (SAB) is a common bloodstream infection with significant mortality. Infectious Disease consultation (IDC) has been shown to improve outcomes and adherence to standards of care (SOC). In our institution, IDC for SAB is not mandatory. Our study was a quality improvement initiative to measure the impact of IDC on patient outcomes and adherence to SOC.MethodsA retrospective, observational study of all SAB cases in adults ≥18 years old at a 1541-bed academic medical center from January 1 to December 31, 2015 was performed. Those meeting inclusion criteria underwent chart review for demographics, co-morbidities, presence of IDC or antimicrobial stewardship team (AST) input, management including follow-up blood culture, echocardiography, antibiotic choice and duration, and outcomes including relapse and 30-day mortality.Results236 patients met inclusion criteria and 174 (74%) had IDC. Patient characterestics were balanced in IDC and no IDC (NIDC) groups including age, sex, co-morbidities, methicillin-resistant SAB rates except for more immunosuppressed hosts, bone and joint infections,and endocarditis (P < 0.05) in the IDC group. SOC including performance of echocardiogram, appropriate antibiotic choice and treatment duration were adhered to more frequently in the IDC group (P < .005). Relapse rates were similar in IDC and NIDC groups (3% vs. 5%, P = 0.44,respectively). Lower 30-day mortality was observed with IDC but did not reach statistical significance (11% vs. 21%, P = .07). Patients with malignancy who had IDC had lower 30-day mortality compared with their counterpart in the NIDC group (6% vs. 35%, P = .01).In the NIDC group, 9/62 (15%) had an AST input that provided recommendations on antibiotic management. When these cases were combined with those with IDC, mortality was significantly improved compared with those without either IDC or AST input (11% vs. 23%, P = 0.04). Multivariate analysis revealed bacteremia clearance within 3 days and presence of AST input or IDC were predictors of survival while age>60 and ICU stay were predictors of mortality (P <.005).ConclusionSimilar to prior studies, IDC was associated with increased adherence to standard management practices. Our study suggests that a pharmacy-driven AST can be an adjunct to IDC in improving outcomes of SAB.Disclosures All authors: No reported disclosures.