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Published on: February 9, 2011
The impact of infectious diseases consultation for children with Staphylococcus aureus bacteremia
Kyle J Whittington1, Yinjiao Ma2, Anne M Butler2
1Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA. wkyle@wustl.edu.
Insights
Pediatric infectious diseases (ID) consultation for Staphylococcus aureus bacteremia improves adherence to quality care indicators in children. While not directly impacting treatment failure in this study, adherence to these indicators is linked to better outcomes.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Health Services Research
Background:
- The impact of infectious diseases (ID) consultation for Staphylococcus aureus bacteremia in children is understudied.
- Existing literature on ID consultation in pediatric S. aureus bacteremia is sparse, with mixed results on clinical outcomes.
- Adult studies show clear benefits of ID consultation for improved outcomes.
Purpose of the Study:
- To assess the impact of pediatric ID consultation on the management and outcomes of S. aureus bacteremia in children.
- To evaluate adherence to quality-of-care indicators (QCIs) following ID consultation.
- To examine the association between ID consultation and treatment failure risk.
Main Methods:
- A cohort study was conducted at St. Louis Children's Hospital from 2011 to 2018.
- Adherence to six established QCIs was assessed for children with S. aureus bacteremia.
- Propensity score methodology was used to analyze the impact of ID consultation on treatment failure (mortality or 90-day readmission).
Main Results:
- Of 306 patients, 193 (63%) received ID consultation.
- ID consultation was associated with increased adherence to all assessed QCIs.
- Adherence to proof-of-cure blood cultures and indicated laboratory studies correlated with improved outcomes.
- Propensity score-weighted analyses showed similar treatment failure risk between consulted and unconsulted groups, though estimates were imprecise due to small event numbers.
Conclusions:
- Infectious diseases consultation in children with S. aureus bacteremia enhances adherence to quality-of-care indicators.
- Some quality-of-care indicators, when adhered to, are associated with improved clinical outcomes in pediatric S. aureus bacteremia.
- This study strengthens evidence for ID consultation improving pediatric care quality and links QCI adherence to better outcomes.
Background:
Despite clear benefit of improved outcomes in adults, the impact of infectious diseases (ID) consultation for Staphylococcus aureus bacteremia in children remains understudied.
Methods:
To assess the impact of pediatric ID consultation on management and outcomes, we conducted a cohort study of children with S. aureus bacteremia at St. Louis Children's Hospital from 2011 to 2018. We assessed adherence to six established quality-of-care indicators (QCIs). We applied propensity score methodology to examine the impact of ID consultation on risk of treatment failure, a composite of all-cause mortality or hospital readmission within 90 days.
Results:
Of 306 patients with S. aureus bacteremia, 193 (63%) received ID consultation. ID consultation was associated with increased adherence to all QCIs, including proof-of-cure blood cultures, indicated laboratory studies, echocardiography, source control, targeted antibiotic therapy, and antibiotic duration. Obtaining proof-of-cure blood cultures and all indicated laboratory studies were associated with improved outcomes. In propensity score-weighted analyses, risk of treatment failure was similar among patients who did and did not receive ID consultation. However, the number of events was small and risk estimates were imprecise.
Conclusions:
For children with S. aureus bacteremia, ID consultation improved adherence to QCIs, some of which were associated with improved clinical outcomes.
Impact:
In children with Staphylococcus aureus bacteremia, consultation by an infectious diseases (ID) physician improved adherence to established quality-of-care indicators (QCIs). The current literature regarding ID consultation in pediatric S. aureus bacteremia is sparse. Three prior international studies demonstrated improved quality of care with ID consultation, though results were disparate regarding clinical outcomes. This article impacts the current literature by strengthening the evidence that ID consultation in children improves adherence to QCIs, and demonstrates that adherence to QCIs improves clinical outcomes.
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