Swetha Ramanathan1, Fritzie S Albarillo2, Margaret A Fitzpatrick1,2, Katie J Suda3,4, Linda Poggensee1, Amanda Vivo1, Martin E Evans5, Makoto Jones6,7, Nasia Safdar8,9, Chris Pfeiffer10,11, Bridget Smith1, Geneva Wilson1,2, Charlesnika T Evans1,12. 1. Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, Illinois, USA. 2. Division of Infectious Diseases, Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA. 3. Department of Veterans Affairs, Center for Health Equity Research & Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA. 4. Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. 5. Department of Veterans Affairs, Lexington VA Medical Center, Lexington, Kentucky, USA. 6. Department of Veterans Affairs, VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA. 7. Division of Epidemiology, Department of Medicine, University of Utah, Salt Lake City, Utah, USA. 8. Department of Veterans Affairs, William S. Middleton Memorial VA Hospital, Madison, Wisconsin, USA. 9. Division of Infectious Diseases, Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA. 10. Department of Veterans Affairs, Portland VA Healthcare System, Portland, Oregon, USA. 11. Division of Infectious Diseases, Department of Medicine, Oregon Health Science University, Portland, Oregon, USA. 12. Center for Health Services and Outcomes Research and Department of Preventive Medicine, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Abstract
Background: Infectious diseases (ID) consultation improves health outcomes for certain infections but has not been well described for Pseudomonas aeruginosa (PA) bloodstream infection (BSI). Therefore, the goal of this study was to examine ID consultation of inpatients with PA BSI and factors impacting outcomes. Methods: This was a retrospective cohort study from January 1, 2012, to December 31, 2018, of adult hospitalized veterans with PA BSI and antibiotic treatment 2 days before through 5 days after the culture date. Multidrug-resistant (MDR) cultures were defined as cultures with resistance to at least 1 agent in ≥3 antimicrobial categories tested. Multivariable logistic regression models were fit to assess the impact of ID consults and adequate treatment on mortality. Results: A total of 3256 patients had PA BSI, of whom 367 (11.3%) were multidrug resistant (MDR). Most were male (97.5%), over 65 years old (71.2%), and White (70.9%). Nearly one-fourth (n = 784, 23.3%) died during hospitalization, and 870 (25.8%) died within 30 days of their culture. Adjusted models showed that ID consultation was associated with decreased in-hospital (odds ratio [OR], 0.47; 95% CI, 0.39-0.56) and 30-day mortality (OR, 0.51; 95% CI, 0.42-0.62). Conclusions: Consultation with ID physicians improves clinical outcomes such as in-hospital and 30-day mortality for patients with PA BSI. ID consultation provides value and should be considered for patients with PA BSI. Published by Oxford University Press on behalf of Infectious Diseases Society of America 2022.
Background: Infectious diseases (ID) consultation improves health outcomes for certain infections but has not been well described for Pseudomonas aeruginosa (PA) bloodstream infection (BSI). Therefore, the goal of this study was to examine ID consultation of inpatients with PA BSI and factors impacting outcomes. Methods: This was a retrospective cohort study from January 1, 2012, to December 31, 2018, of adult hospitalized veterans with PA BSI and antibiotic treatment 2 days before through 5 days after the culture date. Multidrug-resistant (MDR) cultures were defined as cultures with resistance to at least 1 agent in ≥3 antimicrobial categories tested. Multivariable logistic regression models were fit to assess the impact of ID consults and adequate treatment on mortality. Results: A total of 3256 patients had PA BSI, of whom 367 (11.3%) were multidrug resistant (MDR). Most were male (97.5%), over 65 years old (71.2%), and White (70.9%). Nearly one-fourth (n = 784, 23.3%) died during hospitalization, and 870 (25.8%) died within 30 days of their culture. Adjusted models showed that ID consultation was associated with decreased in-hospital (odds ratio [OR], 0.47; 95% CI, 0.39-0.56) and 30-day mortality (OR, 0.51; 95% CI, 0.42-0.62). Conclusions: Consultation with ID physicians improves clinical outcomes such as in-hospital and 30-day mortality for patients with PA BSI. ID consultation provides value and should be considered for patients with PA BSI. Published by Oxford University Press on behalf of Infectious Diseases Society of America 2022.
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