Yet another study demonstrated the importance of infectious diseases (ID) consultation in improving the survival rate of a patient with septicaemia.1 This time, lack of ID consultation was demonstrated to be associated with 4.5 times increase in hazard of death at three months. The subjects of this study were patients hospitalised at the University of Minnesota Medical Center for methicillin-resistant staphylococcus aureus (MRSA), Candida or Pseudomonas bloodstream infections.
In many hospitals, ID consultation is not mandatory in the management of infection. However, many studies have reported that an ID consultation confers benefits, particularly in improving mortality rates in patients with serious infections such as S. aureus bacteraemia and candidaemia (conditions with high morbidity and mortality).2 Realising that not all cases of bloodstream infections are being consulted with ID experts in their centre, researchers investigated the impact of ID consultation on mortality in these cases.
The retrospective cohort study included 229 cases with positive blood cultures, of which 99 were positive for MRSA, 69 for Candida and 61 for Pseudomonas.1 A total of 181 cases were consulted on by an ID expert and 48 cases were not. The information was obtained through the electronic medical records by confirming the presence of an ID consultation note. Time to appropriate antibiotics and intensive care unit admissions were also investigated.
According to the study, three-month mortality of all bloodstream infections was 36%.1 A multivariate analysis revealed that patients without an ID consultation had a 4.5 increased hazard of death at three months (95% CI, 2.7–7.3; p<0.0001) and 5.9 increased hazard of death in hospital (95% CI, 3.2–11.0; p<0.0001) compared with those who received ID consultation.1 Three-month mortality rates were found to be higher in patients without an ID consultation compared with those with an ID consultation for all types of infection (MRSA, 67% versus 22%; Candida, 63% versus 32%; Pseudomonas, 63% versus 32%).1 The study also demonstrated that patients with an ID consultation were 9 times more likely to receive appropriate antimicrobials (95% CI, 1.7–53.3; p=0.011), 6 times more likely to have central lines removed (95% CI, 1.7–20.9; p=0.008), and 4 times more likely to have echocardiography to rule out endocarditis (95% CI, 1.6–11.8; p=0.008).1
The findings of this study show that an ID consultation ensures that patients receive more appropriate care – leading to an improved mortality risk. A potential fourfold decrease in mortality risk suggests a need for a change in ID consultation requirement in the management of bloodstream infections, particularly for MRSA, Candida and Pseudomonas infections. In hospitals without ID experts, these patients should be referred to a centre that is able to provide an appropriate ID consultation.