Association between infectious diseases consultation and mortality in hospitalized patients with Gram-negative bloodstream infection: a retrospective population-wide cohort study

Sean W X Ong; Jin Luo; Daniel J Fridman; Samantha M Lee; Jennie Johnstone; Kevin L Schwartz; Christina Diong; Samir N Patel; Derek R MacFadden; Bradley J Langford; Steven Y C Tong; Kevin A Brown; Nick Daneman

doi:10.1093/cid/ciae282

Association between infectious diseases consultation and mortality in hospitalized patients with Gram-negative bloodstream infection: a retrospective population-wide cohort study

Clin Infect Dis. 2024 May 17:ciae282. doi: 10.1093/cid/ciae282. Online ahead of print.

Authors

Sean W X Ong^{1

2

3

4}, Jin Luo⁴, Daniel J Fridman⁴, Samantha M Lee⁴, Jennie Johnstone^{5

6

7}, Kevin L Schwartz^{4

5

8

9}, Christina Diong⁴, Samir N Patel^{7

8}, Derek R MacFadden¹⁰, Bradley J Langford^{5

8}, Steven Y C Tong^{11

12}, Kevin A Brown^{4

5

8}, Nick Daneman^{1

3

4

8}

Affiliations

¹ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
² Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
³ Sunnybrook Health Sciences Centre, Toronto, Canada.
⁴ ICES, Toronto, Canada.
⁵ Dalla Lana School of Public Health, University of Toronto, Canada.
⁶ Sinai Health, Toronto, Canada.
⁷ Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.
⁸ Public Health Ontario, Toronto, Canada.
⁹ Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada.
¹⁰ Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
¹¹ Department of Infectious Diseases, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
¹² Victorian Infectious Diseases Service, Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.

PMID: 38758977
DOI: 10.1093/cid/ciae282

Abstract

Objectives: Data supporting routine infectious diseases (ID) consultation in Gram-negative bloodstream infection (GN-BSI) are limited. We evaluated the association between ID consultation and mortality in patients with GN-BSI in a retrospective population-wide cohort study in Ontario using linked health administrative databases.

Methods: Hospitalized adult patients with GN-BSI between April 2017 and December 2021 were included. The primary outcome was time to all-cause mortality censored at 30 days, analyzed using a mixed effects Cox proportional hazards model with hospital as a random effect. ID consultation 1-10 days after the first positive blood culture was treated as a time-varying exposure.

Results: Of 30,159 patients with GN-BSI across 53 hospitals, 11,013 (36.5%) received ID consultation. Median prevalence of ID consultation for patients with GN-BSI across hospitals was 35.0% with wide variability (range 2.7-76.1%, interquartile range 19.6-41.1%). 1041 (9.5%) patients who received ID consultation died within 30 days, compared to 1797 (9.4%) patients without ID consultation. In the fully-adjusted multivariable model, ID consultation was associated with mortality benefit (adjusted HR 0.82, 95% CI 0.77-0.88, p < 0.0001; translating to absolute risk reduction of -3.8% or NNT of 27). Exploratory subgroup analyses of the primary outcome showed that ID consultation could have greater benefit in patients with high-risk features (nosocomial infection, polymicrobial or non-Enterobacterales infection, antimicrobial resistance, or non-urinary tract source).

Conclusions: Early ID consultation was associated with reduced mortality in patients with GN-BSI. If resources permit, routine ID consultation for this patient population should be considered to improve patient outcomes.

Keywords: Gram-negative bacteria; bloodstream infections; health administrative data; health services research; infectious diseases.