Telemedicine consults for Staph bacteremia look promising

Use of infectious diseases (ID) telemedicine for management of Staphylococcus aureus bacteremia (SAB) at 10 US hospitals resulted in similar outcomes compared with on-site consultation, researchers reported today in Open Forum Infectious Diseases.

The retrospective cohort study analyzed data on patients hospitalized with SAB belonging to North Caroline-based Atrium Health from September 2016 through December 2017. All hospitals had implemented an antimicrobial stewardship-led SAB bundle, which includes ID consult, appropriate antibiotics, repeat blood cultures until clearance, echocardiograms, and appropriate antibiotic duration. But only half the hospitals had access to on-site ID experts who could provide consultation.

Of the 870 patients admitted during the study period, 676 were admitted to one of five hospitals with on-site, standard of care (SOC) ID consultation, and 194 were admitted to one of five hospitals with telemedicine (TM) ID consultation. The study assessed SAB bundle adherence and compared clinical outcomes in SAB patients.

Among the 738 patients evaluated (576 with SOC, 162 with TM), no differences were seen in overall bundle adherence (SOC 86% vs TM 89%) or in adherence for each bundle component. Analysis of clinical outcomes showed that the SOC and TM groups had similar rates of hospital mortality, 30-day SAB-related readmission, persistent bacteremia, and time to culture clearance. Multivariable analysis showed that the groups did not differ in 30-day mortality when controlling for demographics, bacteremia source, and physiological measures.

The authors say the findings are significant for facilities that don’t have access to on-site ID consultation.

“We found that the use of virtual TM ID consultation may bridge the gap, providing access to specialty care and as a result provide patient outcomes that are not significantly different from similar on-site ID consultation,” they wrote. “With almost half of US hospitals without access to ID consultations, the use of TM consultation could be an alternative option, avoiding the need to transfer the patient to another hospital and likely minimize delays in care.”
May 10 Open Forum Infect Dis abstract

Survey reveals no standard treatment for carbapenem-resistant infections

A survey of more than 1,000 clinicians in 95 countries found wide variability in the management of carbapenem-resistant gram-negative bacteria (CR-GNB) infections, European researchers reported last week in Clinical Microbiology and Infection.

Among the 1,012 clinicians who responded to the 36-question survey, which was disseminated from Apr 15 to Jun 28, 2019, 30% had local guidelines for treating CR-GNB at their facility and 72% had access to ID consultation, with significant discrepancies according to country economic status: 85% in high-income countries vs 59% in upper-medium-income countries and 30% in low-income countries. As for diagnostic resources, 77% of respondents had access to standard susceptibility testing at a local level, with no differences according to income status, but more complex diagnostics were significantly more available in high-income countries.

Targeted regimens varied widely, ranging from 40 regimens for CR Acinetobacter baumannii to more than 100 regimens for CR Enterobacteriaceae. Dual antibiotic combination regimens were the preferred treatment scheme (between 35% and 45% of respondents) despite the lack of evidence, and the most prescribed regimen was carbapenem-polymyxin, irrespective of pathogen and infection source. The main reasons for combination treatment were to improve clinical efficacy (81% of respondents) and to reduce resistance development (51%).

The survey also found widespread disagreement about the meaning of combination therapy.

“Our results showed that the treatment of CR-GNB infections is far from being standardized and clinicians over the world use a wide range of antibiotic strategies and combinations depending on clinical severity, local availability and clinical experience,” the study authors wrote. “These results demonstrate the urgent need for public health focused strategic randomised controlled trials with the involvement of Low and Low-Middle-Income-Countries.”
May 8 Clin Microbiol Infect study