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    Original Investigation
    Infectious Diseases
    February 12, 2020

    Association of Infectious Diseases Consultation With Long-term Postdischarge Outcomes Among Patients With Staphylococcus aureus Bacteremia

    Author Affiliations
    • 1Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
    • 2Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
    • 3Department of Biostatistics, University of Iowa College of Public Health, Iowa City
    • 4Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
    JAMA Netw Open. 2020;3(2):e1921048. doi:10.1001/jamanetworkopen.2019.21048
    Key Points español 中文 (chinese)

    Question  Is infectious diseases consultation associated with improved long-term outcomes for patients with Staphylococcus aureus bacteremia?

    Findings  In this large, multicenter cohort study of 31 002 patients with S aureus bacteremia, infectious diseases consultation during the index hospital stay was associated with reduced risk of all-cause mortality and recurrence of bacteremia for 5 years after discharge.

    Meaning  Investigations of the association of infectious diseases consultations with outcomes among patients with S aureus bacteremia should include long-term follow-up.

    Abstract

    Importance  Staphylococcus aureus bacteremia (SAB) is common and associated with poor long-term outcomes. Previous studies have demonstrated an association between infectious diseases (ID) consultation and improved short-term (ie, within 90 days) outcomes for patients with SAB, but associations with long-term outcomes are unknown.

    Objective  To investigate the association of ID consultation with long-term (ie, 5 years) postdischarge outcomes among patients with SAB.

    Design, Setting, and Participants  This cohort study included all patients (N = 31 002) with a first episode of SAB who were discharged alive from 116 acute care units of the nationwide Veterans Health Administration where ID consultation was offered. Data were collected from January 2003 to December 2014, with follow-up through September 30, 2018. Data analysis was conducted from February to December 2019.

    Exposures  Infectious diseases consultation during the index hospital stay.

    Main Outcomes and Measures  The primary outcome was time to development of a composite event of all-cause mortality or recurrence of SAB within 5 years of discharge. As secondary outcomes, SAB recurrence and all-cause mortality with and without recurrence were analyzed while accounting for semicompeting risks.

    Results  The cohort included 31 002 patients (30 265 [97.6%] men; median [interquartile range] age at SAB onset, 64.0 [57.0-75.0] years). Among 31 002 patients, there were 18 794 (60.6%) deaths, 4772 (15.4%) SAB recurrences, and 20 414 (65.8%) composite events during 5 years of follow-up; 12 773 deaths (68.0%) and 2268 recurrences (47.5%) occurred more than 90 days after discharge. Approximately half of patients (15 360 [49.5%]) received ID consultation during the index hospital stay; ID consultation was associated with prolonged improvement in the composite outcome (adjusted hazard ratio at 5 years, 0.71; 95% CI, 0.68-0.74; P < .001). Infectious diseases consultation was also associated with improved outcomes when all-cause mortality without recurrence and SAB recurrence were analyzed separately (all-cause mortality without recurrence: adjusted hazard ratio at 5 years, 0.77; 95% CI, 0.74-0.81; P < .001; SAB recurrence: adjusted hazard ratio at 5 years, 0.68; 95% CI, 0.64-0.72; P < .001).

    Conclusions and Relevance  Having an ID consultation during the index hospital stay among patients with SAB was associated with improved postdischarge outcomes for at least 5 years, suggesting that contributions of ID specialists to management during acute infection may have a substantial influence on long-term outcomes. Further investigations of the association of ID consultation with outcomes after S aureus should include long-term follow-up.

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