Management of S. aureus bacteraemia in the Netherlands: infectious diseases consultation improves outcome

Background: Staphylococcus aureus bacteraemia is associated with a high mortality rate. Previously it has been shown that consultation by an internist-infectious diseases specialist (IDS) improves the outcome of patients. In this study, we evaluated the differences in management and outcome between patients with, and those without IDS consultation. Methods: All adult patients with a positive blood culture for S. aureus from January 2010 to December 2013 were retrospectively identified with the electronic registration system of our Laboratory for Medical Microbiology. Clinical and microbiological characteristics were retrieved from the electronic patient files, as well as information on bedside consultation by an IDS. Results: A total of 234 patients with S. aureus bacteraemia were included in the study, of whom 77.8% were consulted by an IDS. Management of patients with IDS consultation was more often according to guidelines than was the case without consultation by an IDS; follow up blood cultures were taken more often (97.8% vs. 80.8%, p < 0.001), patients received echocardiography more often (70.9% vs. 50.0%, p = 0.007), and they were more often treated adequately (86.6% vs. 59.2%, p < 0.001). The detection rate of complications in the IDS group was higher (59.3% vs. 32.7%, p = 0.001) and 30-day mortality rate was lower (12.1% vs. 23.1%, p = 0.04). This was confirmed by multivariate analysis. Conclusion: In patients with a S. aureus bacteraemia, bedside consultation by an IDS results in better adherence to diagnostic and treatment guidelines, with higher detection of complications and a higher survival rate.