Enterococcus faecalis bloodstream infection: does infectious disease specialist consultation make a difference?

Area of Science:

• Infectious Diseases
• Internal Medicine
• Critical Care Medicine

Background:

• Enterococcus faecalis bloodstream infection (BSI) presents a significant clinical challenge.
• High rates of mortality and relapse are associated with E. faecalis BSI.
• Optimizing management strategies is crucial for improving patient outcomes.

Purpose of the Study:

• To investigate the impact of infectious diseases specialist consultation (IDC) on mortality and relapse in E. faecalis BSI.
• To identify factors associated with adverse outcomes in patients with E. faecalis BSI.
• To evaluate adherence to quality-of-care indicators (QCIs) in E. faecalis BSI management.

Main Methods:

• Prospective cohort study of adult patients with E. faecalis BSI at a tertiary-care center.
• Evaluation of management based on evidence-based quality-of-care indicators (QCIs).
• Multivariate logistic regression analysis to determine factors associated with 90-day mortality or relapse.

Main Results:

• Infectious diseases specialist consultation (IDC) was associated with improved adherence to 5 QCIs.
• Severe sepsis or septic shock at onset significantly increased the risk of 90-day mortality or relapse (HR 4.32).
• A deep-seated focus of infection was associated with higher mortality, while a superficial focus showed a protective effect (HR 0.33).

Conclusions:

• Enterococcus faecalis bacteremia is linked to substantial mortality.
• Infectious diseases specialist consultation (IDC) plays a vital role in enhancing diagnostic and therapeutic strategies for E. faecalis BSI.
• Early recognition and management of severe sepsis and deep-seated infections are critical for reducing mortality.