Enterococcal Bacteremia and Potential Benefit of Infectious Disease Consultation

The following article is a part of conference coverage from the IDWeek 2021, being held virtually from September 29 to October 3, 2021. The team at Infectious Disease Advisor will be reporting on the latest news and research conducted by leading experts in the field. Check back for more from the IDWeek 2021.

In patients infected with Enterococcus species, there were no differences observed in regard to composite failure rates among those who did or did not undergo an infectious disease consultation (IDC); however, treatment adherence was increased among those who underwent IDC, according to research presented at IDWeek, held virtually from September 29 to October 3, 2021.

Researchers conducted a retrospective multicenter observational cohort study among a total of 250 adult patients with at least 1 positive blood culture infected with Enterococcus species. The researchers sought to determine whether IDC consultation is associated with either a decreased risk for mortality or increased treatment adherence. The primary outcome was composite clinical failure, including persistent blood cultures or fever for 5 days and in-hospital mortality. Secondary outcomes were adherence to a treatment bundle including empiric antibiotics, echocardiography, duration of treatment, and repeat blood cultures.

Of patients included in the study62.0% underwent IDC. Compared with patients who did not undergo IDC, endocarditis occurred more frequently among those who underwent IDC (0% vs 20%, respectively; P <.0001), as well as bone and joint infections (1.1% vs 13.5%, respectively; P =.001). However, the researchers noted that urinary tract infections were more common among patients in the non-IDC group vs those in the IDC group (39.0% vs 16.8%; P <.0001). Additional comparisons between the IDC and Non-IDC groups showed that patients in the IDC group had more murmurs on initial examination (21.3% vs 6.3%; P =.002), increased prosthetic device use (49.7% vs 27.4%; P =.001), and an increased number of NOVA (number of positive blood cultures, origin of bacteremia, previous valve disease, auscultation of heart murmur) scores greater than or equal to 4 (40.6% vs 18.9%; P <.0001). Of patients included in the study, the majority of infections were caused by E faecalis species (78.4%), for which most were susceptible to vancomycin and ampicillin at 90.4% and 92.4%, respectively.

Clinical composite failure occurred in 22.6% of patients in the IDC group and 16.8% in the non-IDC group (P =.274). Of patients in both groups, adherence to the treatment bundle and treatment with ampicillin were both increased among those in the IDC group vs those in the non-IDC group(47.1% vs 22.1%; P <.0001). In addition, a greater number of patients in the non-IDC group received treatment with vancomycin vs those in the IDC group (24.4% vs 17.4%; P =.068). The researchers performed a multivariate analysis and found that vasopressors were the only independent predictor of the primary outcome (odds ratio, 9.3; 95% CI, 3.5-24.8; P <.0001).

The researchers concluded that “IDC demonstrated stewardship benefits with regards to vancomycin usage.”

Reference

Shephard EA, Mondy KE, Reveles KR, Jaso T, Rose DT. Does an infectious disease consultation improve clinical outcomes and treatment bundle adherence for enterococcal bacteremia in a multicenter healthcare system. Presented at: IDWeek; September 29 to October 3, 2021. Poster 185.

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