Effect of Infectious Disease Consult on 30-Day Readmissions Among Patients with Staphylococcus aureus Bacteremia Público

Abstract

Staphylococcus aureus bacteremia (SAB), defined as the isolation of S. aureus from at least one blood culture from a symptomatic patient, is the second most common cause of hospital bloodstream infections and one of the leading causes of infective endocarditis. Infectious disease consultation (IDC) has been associated with improved SAB management and reduced mortality among patients with SAB, but few studies have examined the association with 30-day readmissions in this population. This study explored the association between IDC and 30-day all-cause hospital readmission in 939 index admissions with SAB admitted to two 500-bed academic medical centers between 2010 and 2014. In multivariate regression, IDC had a protective, but non-significant, effect against 30-day all-cause readmissions (adjusted odds ratio [aOR]: 0.9, 95% confidence interval [CI]: 0.7, 1.2). Delayed time to IDC (> 7 days) from positive culture result also had a deleterious, though non-significant, effect on readmissions compared to IDC within two days of positive culture (aOR: 1.5, 95% CI: 0.6, 4.1). In this study, a Charlson score of 3 or greater (aOR: 1.5, 95% CI: 1.1, 2.0), lymphoma (aOR: 3.1, 95% CI: 1.1, 8.3), low albumin (aOR: 1.5, 95% CI: 1.1, 2.1), and MRSA bacteremia (aOR: 1.5, 95% CI: 1.1, 2.0) were associated with readmission, while end-stage renal disease (ESRD), other types of cancer, liver disease, and community onset bacteremia were not. These data suggest that IDC may be protective for hospital readmission, but the observed relationship may be confounded by variables not measured in this population. Further studies should focus on improved measures of acuity to better assess the relationship of IDC to readmission.

Table of Contents

Chapter I: Background and Literature Review 1

Staphylococcus aureus bacteremia (SAB) 1

Infectious Disease Consultation (IDC) 1

IDC and SAB management 2

IDC and outcomes among patients with SAB 3

Readmissions 5

Chapter II: Manuscript 6

Introduction 7

Methods 8

Results 10

Discussion 13

References 20

Tables 23

Table 1. Characteristics of index admissions with S. aureus bacteremia (SAB), 2010-2014 23

Table 2. Bivariate and multivariate associations of exposure and covariates and 30-day all-cause readmission following index admission with S. aureus bacteremia (SAB), 2010-2014 25

Table 3. Bivariate association of secondary/intermediary outcomes with infectious disease consultation (IDC) and 30-day readmission following index admission with S. aureus bacteremia, 2010-2014 26

Table 4. Association of time from positive culture to infectious disease consult (IDC) and 30-day all-cause readmission following index admission with S. aureus bacteremia evaluated by an infectious disease (ID) physician, 2010-2014 27

Table 5. Association of infectious disease (ID) physician affiliation and 30-day all-cause readmission following index admission with S. aureus bacteremia evaluated by an ID physician at Emory University Hospital Midtown (EUHM), 2010-2014 28

Figures 29

Figure 1. Selection criteria for study in patients with S. aureus bacteremia (SAB) 29

Figure 2. Total admissions with positive S. aureus bacteremia (SAB) culture and SAB admissions with infectious disease consult (IDC), 2010-2014 30

Figure 3. Time from positive culture result to first infectious disease consult (IDC) among patients with S. aureus bacteremia (SAB), 2010-2014 31

Figure 4. Time to readmission by infectious disease consult (IDC) occurrence during index admission among patients with S. aureus bacteremia (SAB), 2010-2014 32

Figure 5. Survival curves for time to readmission by infectious disease consult (IDC) occurrence during index admission among patients with S. aureus bacteremia (SAB), 2010-2014 33

Chapter III: Summary, Public Health Implications, Future directions 34

Appendix 36

Appendix Table 1. Studies on the association of infectious disease consult (IDC) and adverse outcomes in S. aureus bacteremia (SAB) cases by type of outcome 36

Appendix Table 2. Models fit to data, post-collinearity and interaction assessment, pre-confounding assessment 38

Appendix Table 3. Characteristics of index admissions with S. aureus bacteremia (SAB), 2010-2014, by hospital 39

Appendix Figure 1. Methicillin-susceptible S. aureus (MSSA) versus methicillin-resistant S. aureus MRSA among patients with S. aureus bacteremia (SAB), 2010-2014 41

Appendix Figure 2. Time from positive culture result to first infectious disease consult (IDC) among patients with S. aureus bacteremia (SAB) by hospital, 2010-2014 42

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Medicine and Surgery Health Sciences, Epidemiology
Palabra Clave	Readmissions Infectious Disease Bacteremia Epidemiology Staphylococcus aureus
Committee Chair / Thesis Advisor	Jacob, Jesse Thomas, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Hospital or other health care provider

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