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The impact of infectious diseases consultation for children with Staphylococcus aureus bacteremia.
Whittington, Kyle J; Ma, Yinjiao; Butler, Anne M; Hogan, Patrick G; Ahmed, Faria; Flowers, JessieAnn; Milburn, Grace; Morelli, John J; Newland, Jason G; Fritz, Stephanie A.
Afiliación
  • Whittington KJ; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA. wkyle@wustl.edu.
  • Ma Y; Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
  • Butler AM; Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
  • Hogan PG; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
  • Ahmed F; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
  • Flowers J; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
  • Milburn G; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
  • Morelli JJ; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
  • Newland JG; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
  • Fritz SA; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA. fritz.s@wustl.edu.
Pediatr Res ; 92(6): 1598-1605, 2022 12.
Article en En | MEDLINE | ID: mdl-35982140
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.
Asunto(s)

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Infecciones Estafilocócicas / Enfermedades Transmisibles / Bacteriemia Tipo de estudio: Observational_studies / Risk_factors_studies Límite: Adult / Child / Humans Idioma: En Revista: Pediatr Res Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Infecciones Estafilocócicas / Enfermedades Transmisibles / Bacteriemia Tipo de estudio: Observational_studies / Risk_factors_studies Límite: Adult / Child / Humans Idioma: En Revista: Pediatr Res Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos