Chiong, Fabian

Wasef, Mohammed S

Liew, Kwee Chin

Cowan, Raquel

Tsai, Danny

Lee, Yin Peng

Croft, Larry

Harris, Owen

Gwini, Stella May

Athan, Eugene

2021-07-09

BACKGROUND: Pseudomonas aeruginosa bacteraemia (PAB) is associated with high mortality. The benefits of infectious diseases consultation (IDC) has been demonstrated in Staphylococcal aureus bacteraemia and other complex infections. Impact of IDC in PAB is unclear. This study aimed to evaluate the impact of IDC on the management and outcomes in patients with PAB. METHODS: This is a retrospective cohort single-centre study from 1 November 2006 to 29 May 2019, in all adult patients admitted with first episode of PAB. Data collected included demographics, clinical management and outcomes for PAB and whether IDC occurred. In addition, 29 Pseudomonas aeruginosa (PA) stored isolates were available for Illumina whole genome sequencing to investigate if pathogen factors contributed to the mortality. RESULTS: A total of 128 cases of PAB were identified, 71% received IDC. Patients who received IDC were less likely to receive inappropriate duration of antibiotic therapy (4.4%; vs 67.6%; p < 0.01), more likely to be de-escalated to oral antibiotic in a timely manner (87.9% vs 40.5%; p < 0.01), undergo removal of infected catheter (27.5% vs 13.5%; p = 0.049) and undergo surgical intervention (20.9% vs 5.4%, p = 0.023) for source control. The overall 30-day all-cause mortality rate was 24.2% and was significantly higher in the no IDC group in both unadjusted (56.8% vs 11.0%, odds ratio [OR] = 10.63, p < 0.001) and adjusted analysis (adjusted OR = 7.84; 95% confidence interval, 2.95-20.86). The genotypic analysis did not reveal any PA genetic features associated with increased mortality between IDC versus no IDC groups. CONCLUSION: Patients who received IDC for PAB had lower 30-day mortality, better source control and management was more compliant with guidelines. Further prospective studies are necessary to determine if these results can be validated in other settings.

Department of Medicine, Alice Springs Hospital, PO Box 2234, Alice Springs, NT, 0871, Australia. Fabian.Chiong@nt.gov.au.

Bankstown-Lidcombe Hospital, Sydney, Australia.

Department of Infectious Diseases, University Hospital Geelong, Geelong, Australia.

Australian Clinical Laboratories, Geelong, Australia.

University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Australia.

Rural and Remote Health NT, Flinders University, Alice Springs, NT, Australia.

Deakin Genomic Centre, Deakin University, Geelong, Australia.

School of Life and Environmental Sciences, Deakin University, Geelong, Australia.

Asian Institute of Medicine, Science and Technology University, Bedong, Kedah, Malaysia.

University Hospital Geelong, Geelong, Australia.

School of Medicine Deakin University, Geelong, Australia.

© 2021. The Author(s).

BMC Infect Dis. 2021 Jul 9;21(1):671. doi: 10.1186/s12879-021-06372-5.

0000-0003-3672-0846

https://pubmed.ncbi.nlm.nih.gov/34243714/?otool=iaurydwlib

https://hdl.handle.net/10137/11817

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The impact of infectious diseases consultation on the management and outcomes of Pseudomonas aeruginosa bacteraemia in adults: a retrospective cohort study.

Journal Article

Publication