Details

Autor(en) / Beteiligte

• Forsblom, E.
• Ruotsalainen, E.
• Ollgren, J.
• Järvinen, A.

Titel

Telephone Consultation Cannot Replace Bedside Infectious Disease Consultation in the Management of Staphylococcus aureus Bacteremia

Ist Teil von

• Clinical infectious diseases, 2013-02, Vol.56 (4), p.527-535

Ort / Verlag

Oxford: Oxford University Press

Erscheinungsjahr

2013

Link zum Volltext

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• Background. Infectious disease specialist (IDS) consultation improves the outcome of Staphylococcus aureus bacteremia (SAB). Although telephone consultations constitute a substantial part of IDS consultations, their impact on treatment outcome lacks evaluation. Methods. We retrospectively followed 342 SAB episodes with 90-day follow-up, excluding 5 methicillin-resistant S. aureus SAB cases. Patients were grouped according to bedside, telephone, or no IDS consultation within the first week. Patients with fatal outcome within 3 days after onset of SAB were excluded to allow for the possibility of death occurring before IDS consultation. Results. Seventy-two percent of patients received bedside, 18% telephone, and 10% no IDS consultation. Patients with bedside consultation were less often treated in an intensive care unit during the first 3 days compared to those with telephone consultation (odds ratio [OR], 0.53; 95% confidence interval [CI], .29–.97; P = .037; 21% vs 34%), with no other initial differences between these groups. Patients with bedside consultation more often had deep infection foci localized as compared to patients with telephone consultation (OR, 3.11; 95% CI, 1.74–5.57; P < .0001; 78% vs 53%). Patients with bedside consultation had lower mortality than patients with telephone consultation at 7 days (OR, 0.09; 95% CI, .02–.49; P = .001; 1% vs 8%), at 28 days (OR, 0.27; 95% CI, .11–.65; P = .002; 5% vs 16%) and at 90 days (OR, 0.25; 95% CI, .13–.51; P < .0001; 9% vs 29%). Considering all prognostic markers, 90-day mortality for telephone-consultation patients was higher (OR, 2.31; CI, 95% 1.22–4.38; P = .01) as compared to bedside consultation. Conclusions. Telephone IDS consultation is inferior to bedside IDS consultation.