Infectious disease consultation (IDC) was associated with a 40% reduced risk of death in gram-negative bacteremia patients, according to a multicenter study published yesterday in Clinical Infectious Diseases.
To evaluate the impact of IDC on outcomes in patients with gram-negative bloodstream infections (GN-BSI), a team of US researchers conducted a retrospective observational study on GN-BSI patients admitted to 24 US hospitals from January to December 2019. All sites had an active antimicrobial stewardship program with physician and pharmacy leadership, but none had mandatory IDC for GN-BSI, and stewardship interventions and guidelines for GN-BSI varied. The primary exposure was IDC versus no IDC, and the primary outcome was 30-day mortality.
Overall, there were 4,861 GN-BSI episodes, of which 2,814 (54%) had IDC; 681 (14%) resulted in 30-day mortality (12% vs 17% in IDC and no IDC, respectively).
Expanding infectious disease knowledge and training is essential.
After propensity score weighting to account for unmeasured confounders, patients who had an IDC had significantly reduced risk of 30-day mortality (hazard ratio [HR], 0.60; 95% confidence interval [CI], 0.47 to 0.77), and the reduced risk persisted at 90 days (HR, 0.70; 95% CI, 0.57 to 0.86). There was no difference in risk of 30-day readmission for patients with or without an IDC (HR, 1.09; 95% CI, 0.77 to 1.54) or risk of 30-day recurrent bacteremia (HR, 1.33; 95% CI, 0.70 to 2.52)
"IDC plays an important role in the management of GN-BSI, and expanding infectious disease knowledge and training is essential," the study authors wrote. "Until then, understanding where and when this limited resource is most beneficial is needed."