Infektiologische Konsile bei Patienten mit Staphylococcus-aureus-Bakteriämie – eine retrospektive Beobachtungsstudie am Universitätsklinikum Jena

Zusammenfassung

Einleitung Staphylococcus-aureus-Bakteriämien sind schwere Infektionserkrankungen mit oftmals langwierigen klinischen Verläufen und hoher Sterblichkeit. Retrospektive Studien zeigen, dass infektiologische Konsile die Adhärenz an Therapiestandards erhöhen und das Überleben von Staphylococcus-aureus-Bakteriämie-Patienten verbessern können.

Methoden In dieser retrospektiven, monozentrischen Beobachtungsstudie wurde der Einfluss von infektiologischen Konsilen auf das Überleben von Patienten mit Staphylococcus-aureus-Bakteriämie am Universitätsklinikum Jena mittels logistischer Regressions- und Überlebenszeitanalyse untersucht. Der primäre Endpunkt der Studie war die Krankenhaussterblichkeit.

Ergebnisse Insgesamt wurden Daten von 297 Patienten (≥ 18 Jahre) mit Staphylococcus-aureus-Bakteriämie im Zeitraum zwischen Dezember 2012 und August 2015 analysiert. Bei 159 dieser Patienten wurde ein infektiologisches Konsil durchgeführt. Die Durchführung eines Konsils war mit einer geringeren Krankenhaussterblichkeit assoziiert (23 % ohne Konsil, 11 % mit Konsil; multiple Regressionsanalyse: Odds-Ratio = 0,27 [95 %-Konfidenzintervall: 0,12 – 0,64]; p = 0,003). Ferner gab es Unterschiede bei der Erfüllung definierter Qualitätsindikatoren der Behandlung einer Staphylococcus-aureus-Bakteriämie. Dabei war die komplette Umsetzung aller im Konsil empfohlenen Maßnahmen mit der niedrigsten Krankenhaussterblichkeit verbunden.

Diskussion Die Mitbehandlung von Patienten mit Staphylococcus-aureus-Bakteriämie durch klinische Infektiologen war mit einer geringeren Krankenhaussterblichkeit assoziiert.

Abstract

Background Staphylococcus aureus bacteraemia is frequently associated with complications and a high mortality. Recent retrospective studies provide evidence that infectious disease specialist consultations improve the outcome of patients with Staphylococcus aureus bacteraemia by increasing adherence to treatment standards.

Methods In this retrospective, single-centre observational study, we investigated the impact of infectious disease consultations on the outcome of patients with Staphylococcus aureus bacteraemia at the Jena University Hospital applying logistic regression and survival analyses. The primary endpoint was intra-hospital mortality.

Results We analysed patients (≥ 18 years) with Staphylococcus aureus bacteraemia between December 2012 and August 2015 (n = 297), of whom 159 received infectious disease consultations. Specialist consultations were associated with lower intra-hospital mortality (23 % without consultations, 11 % with consultations; multiple regression analysis: odds ratio = 0.27 [95 % confidence interval: 0.12 – 0.64]; p = 0.003). Furthermore, the adherence to defined quality-of-care indicators differed. The complete implementation of all recommendations was associated with the lowest intra-hospital mortality rates.

Conclusion Infectious disease consultations in patients with Staphylococcus aureus bacteraemia were associated with a lower intra-hospital mortality rate.

Schlüsselwörter

Staphylococcus-aureus-Bakteriämie - infektiologische Konsile - Behandlungsqualität - antimikrobielle Therapie/Antibiotic Stewardship - interdisziplinärer Therapieansatz

Key words

Staphylococcus aureus bacteraemia - infectious disease consultation - quality of care - antimicrobial therapy/antibiotic-stewardship - interdisciplinary management

• Literatur

• 1 Asgeirsson H, Kristjansson M, Kristinsson KG. et al. Staphylococcus aureus bacteraemia--Nationwide assessment of treatment adequacy and outcome. J Infect 2011; 62: 339-346
• 2 Bellomo R, Ronco C, Kellum JA. et al. Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004; 8: R204-R212
• 3 Bender R. Calculating confidence intervals for the number needed to treat. Control Clin Trials 2001; 22: 102-110
• 4 Benfield T, Espersen F, Frimodt-Moller N. et al. Increasing incidence but decreasing in-hospital mortality of adult Staphylococcus aureus bacteraemia between 1981 and 2000. Clin Microbiol Infect 2007; 13: 257-263
• 5 Charlson ME, Pompei P, Ales KL. et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of chronic diseases 1987; 40: 373-383
• 6 El Atrouni WI, Knoll BM, Lahr BD. et al. Temporal trends in the incidence of Staphylococcus aureus bacteremia in Olmsted County, Minnesota, 1998 to 2005: a population-based study. Clin Infect Dis 2009; 49: e130-e138
• 7 Fowler Jr VG, Sanders LL, Sexton DJ. et al. Outcome of Staphylococcus aureus bacteremia according to compliance with recommendations of infectious diseases specialists\: experience with 244 patients. Clin Infect Dis 1998; 27: 478-486
• 8 Friedman ND, Kaye KS, Stout JE. et al. Health care--associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med 2002; 137: 791-797
• 9 Gotland N, Uhre ML, Mejer N. et al. Long-term mortality and causes of death associated with Staphylococcus aureus bacteremia. A matched cohort study. The J Infect 2016; 73: 346-357
• 10 Kaasch AJ, Rieg S, Hellmich M. et al. Differential time to positivity is not predictive for central line-related Staphylococcus aureus bloodstream infection in routine clinical care. J Infect 2014; 68: 58-61
• 11 Kern WV. Management of Staphylococcus aureus bacteremia and endocarditis: progresses and challenges. Curr Opin Infect Dis 2010; 23: 346-358
• 12 Klevens RM, Morrison MA, Nadle J. et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007; 298: 1763-1771
• 13 Laupland KB, Lyytikainen O, Sogaard M. et al. The changing epidemiology of Staphylococcus aureus bloodstream infection: a multinational population-based surveillance study. Clin Microbiol Infect 2013; 19: 465-471
• 14 Lenz R, Leal JR, Church DL. et al. The distinct category of healthcare associated bloodstream infections. BMC Infect Dis 2012; 12: 85
• 15 Lesens O, Methlin C, Hansmann Y. et al. Role of comorbidity in mortality related to Staphylococcus aureus bacteremia: a prospective study using the Charlson weighted index of comorbidity. Infect Control Hosp Epidemiol 2003; 24: 890-896
• 16 Liu C, Bayer A, Cosgrove SE. et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis 2011; 52: 285-292
• 17 Lopez-Cortes LE, Del Toro MD, Galvez-Acebal J. et al. Impact of an evidence-based bundle intervention in the quality-of-care management and outcome of Staphylococcus aureus bacteremia. Clin Infect Dis 2013; 57: 1225-1233
• 18 Newcombe RG. Interval estimation for the difference between independent proportions: comparison of eleven methods. Stat Med 1998; 17: 873-890
• 19 Nguyen CT, Gandhi T, Chenoweth C. et al. Impact of an antimicrobial stewardship-led intervention for Staphylococcus aureus bacteraemia: a quasi-experimental study. J Antimicrob Chemother 2015; 70: 3390-3396
• 20 Pletz MW, Tacconelli E, Welte T. Antibiotic Stewardship 2.0. Individualization of therapy. Internist (Berl) 2017; 58: 657-665
• 21 Rieg S, Kern WV. Die nosokomiale Staphylococcus aureus-Bakteriämie. Krankenhaushygiene up2date 2011; 6: 261-274
• 22 Rieg S, Peyerl-Hoffmann G, de With K. et al. Mortality of S. aureus bacteremia and infectious diseases specialist consultation--a study of 521 patients in Germany. J Infect 2009; 59: 232-239
• 23 Saunderson RB, Gouliouris T, Nickerson EK. et al. Impact of routine bedside infectious disease consultation on clinical management and outcome of Staphylococcus aureus bacteraemia in adults. Clin Microbiol Infect 2015; 21: 779-785
• 24 Schmitz RP, Rissner F, Brunkhorst FM. The Thuringian registry for bloodstream infections, antibiotic resistance and the practice of blood culture sampling--AlertsNet. Intern J Antimicrobiol Agent 2015; 46 Suppl 1 S5-S9
• 25 Seifert H, Abele-Horn M, Fätkenheuer G. et al. MiQ Blutkulturdiagnostik Sepsis, Endokarditis, Katheterinfektionen, Teil I. 2007
• 26 Seifert H, Wisplinghoff H, Kaasch A. et al. Epidemiology, course and prognosis of Staphylococcus aureus bacteremia--Preliminary results from the INSTINCT (INvasive STaphylococcus aureus INfection CohorT) cohort. Dtsch Med Wochenschr 2008; 133: 340-345
• 27 Tong SY, Davis JS, Eichenberger E. et al. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev 2015; 28: 603-661
• 28 Townsend J, Pelletier J, Peterson G. et al. Quality Improvement of Staphylococcus aureus Bacteremia Management and Predictors of Relapse-free Survival. Am J Med 2016; 129: 195-203
• 29 Vogel M, Schmitz RP, Hagel S. et al. Infectious disease consultation for Staphylococcus aureus bacteremia – A systematic review and meta-analysis. J Infect 2015; 72: 19-28
• 30 Weis S, Hagel S, Schmitz RP. et al. Study on the utility of a statewide counselling programme for improving mortality outcomes of patients with Staphylococcus aureus bacteraemia in Thuringia (SUPPORT): a study protocol of a cluster-randomised crossover trial. BMJ Open 2017; 7: e013976
• 31 Weis S, Kaasch AJ, Rieg S. et al. Staphylococcus aureus bacteremia – a distinct entity. Dtsch Med Wochenschr 2015; 140: 982-989