Letter to the Editor

Impact of infectious-disease specialist consultations on outcomes of Staphylococcus aureus bacteremia in a hospital with a low volume of patients with S. aureus bacteremia

Pathogenic microbial infections have been regarded as one of the serious factors triggering serious food poisoning and infectious disease outbreaks. Therefore, early detection of pathogenic bacteria is of great importance for food safety, environmental monitoring, and clinical diagnosis. Here, nanofiber sensing films for the visual detection of S. aureus concentrations using polyvinyl alcohol (PVA) as a substrate and anthocyanin as an indicator material were prepared by electrostatic spinning technology. To avoid the loss of dye migration and side effects on the bacteria during the contact detection method, the headspace method was used to detect the concentration of bacteria. The results show that the fiber films can monitor S. aureus at 2 × 10² cfu/mL (ΔE = 7.6) by headspace. Scatter density matrix and correlation analysis yielded that the b* value of the film was the main factor in the variation of bacterial concentrations. Combined with a support vector machine (SVM) supervised learning algorithm for non-linear data, the model was trained to accurately classify S. aureus concentrations with an accuracy of 91%, which is important for accurately controlling pathogenic bacteria and safeguarding human health.

To evaluate a pharmacist-facilitated evidence-based bundle (EBB) initiative with infectious disease consultation (IDC) for Staphylococcus aureus bacteremia (SAB).

This was a before-and-after quasi-experimental study of adult patients with SAB before and after the pharmacist-facilitated EBB initiative, which included IDC, timely definitive antibiotics, source control, echocardiography, and repeat blood cultures.

Ninety and 111 patients were included in pre- and post-intervention cohorts, respectively. We observed significant increases in adherence to all 5 (4.4% vs 68.5%, P < 0.001) and 4 (10.0% vs 76.6%, P < 0.001) EBB elements. Time to definitive antibiotics (48 vs 16 hours, P < 0.001), time to IDC (43.5 vs 32 hours, P < 0.001), SAB duration (95 vs 66 hours, P = 0.009), persistent SAB (18.9% vs 9.0%, P = 0.041), and length of stay (14 vs 13 days, P = 0.027) also improved. No statistically significant differences for SAB-related readmission or all-cause mortality were observed.

Our pharmacist-facilitated SAB initiative was associated with improved EBB adherence and clinical outcomes.

Mortality and morbidity of Staphylococcus aureus bacteremia (SAB) still remains considerably high. We aimed to evaluate the impact of infectious disease consultation (IDC) on the management and outcomes of patients with SAB.

We systematically searched 3 publication databases from inception to 31st May 2015 and reference lists of identified primary studies.

Our search returned 2874 reports, of which 18 fulfilled the inclusion criteria, accounting for 5337 patients. Overall 30-day mortality was 19.95% [95% CI 14.37–27.02] with a significant difference in favour of the IDC group (12.39% vs 26.07%) with a relative risk (RR) of 0.53 [95% CI 0.43–0.65]. 90-day mortality and relapse risk for SAB were also reduced significantly with RRs of 0.77 [95% CI 0.64–0.92] and 0.62 [95% CI 0.39–0.99], respectively. Both, the appropriateness of antistaphylococcal agent and treatment duration was improved by IDC (RR 1.14 [95% CI 1.08–1.20] and 1.85 [95% CI 1.39–2.46], respectively). Follow-up blood cultures and echocardiography were performed more frequently following IDC (RR 1.35 [95% CI 1.25–1.46] and 1.98 [95% CI 1.66–2.37], respectively).

Evidence-based clinical management enforced by IDC may improve outcome of patients with SAB. Well-designed cluster-randomized controlled trials are needed to confirm this finding from observational studies.

Given the current bacterial resistance crisis, antimicrobial stewardship programmes are of the utmost importance. We present a narrative review of the impact of infectious disease specialists (IDSs) on the quality and quantity of antibiotic use in acute-care hospitals, and discuss the main factors that could limit the efficacy of IDS recommendations. A total of 31 studies were included in this review, with a wide range of infections, hospital settings, and types of antibiotic prescription. Seven of 31 studies were randomized controlled trials, before/after controlled studies, or before/after uncontrolled studies with interrupted time-series analysis. In almost all studies, IDS intervention was associated with a significant improvement in the appropriateness of antibiotic prescribing as compared with prescriptions without any IDS input, and with decreased antibiotic consumption. Variability in the antibiotic prescribing practices of IDSs, informal (curbside) consultations and the involvement of junior IDSs are among the factors that could have an impact on the efficacy of IDS recommendations and on compliance rates, and deserve further investigation. We also discuss possible drawbacks of IDSs in acute-care hospitals that are rarely reported in the published literature. Overall, IDSs are valuable to antimicrobial stewardship programmes in hospitals, but their impact depends on many human and organizational factors.