Successful Use of Telemedicine Infectious Diseases Consultation With an Antimicrobial Stewardship-Led Staphylococcus aureus Bacteremia Care Bundle

Jacqueline Meredith; Jennifer Onsrud; Lisa Davidson; Leigh Ann Medaris; Marc Kowalkowski; Kristin Fischer; Jennifer Priem; Michael Leonard; Lewis McCurdy

doi:10.1093/ofid/ofab229

Successful Use of Telemedicine Infectious Diseases Consultation With an Antimicrobial Stewardship-Led Staphylococcus aureus Bacteremia Care Bundle

Open Forum Infect Dis. 2021 May 10;8(6):ofab229. doi: 10.1093/ofid/ofab229. eCollection 2021 Jun.

Authors

Jacqueline Meredith¹, Jennifer Onsrud¹, Lisa Davidson², Leigh Ann Medaris², Marc Kowalkowski³, Kristin Fischer¹, Jennifer Priem³, Michael Leonard², Lewis McCurdy²

Affiliations

¹ Antimicrobial Support Network, Atrium Health, Charlotte, North Carolina, USA.
² Department of Internal Medicine, Division of Infectious Diseases, Atrium Health, Charlotte, North Carolina, USA.
³ Centers for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, USA.

Abstract

Background: Telemedicine (TM) programs can be implemented to deliver specialty care through virtual platforms and overcome geographic/resource constraints. Few data exist to describe outcomes associated with TM-based infectious diseases (ID) management. The purpose of this study was to compare outcomes associated with TM and onsite standard-of-care (SOC) ID consultation after implementation of an antimicrobial stewardship (AMS)-led Staphylococcus aureus bacteremia (SAB) bundle.

Methods: A retrospective cohort study was conducted on the effects of a SAB bundle comparing ID consult delivery (SOC or TM) at 10 US hospitals within Atrium Health in adult patients admitted from September 2016 through December 2017. The type of ID consult provided was based on the admitting hospital; no hospital had both modalities. Bundle components included the following: (1) ID consult, (2) appropriate antibiotics, (3) repeat blood cultures until clearance, (4) echocardiogram obtainment, and (5) appropriate antibiotic duration. The AMS facilitated bundle initiation and compliance. The primary outcome was bundle adherence between groups. Differences in clinical outcomes were also assessed.

Results: We evaluated 738 patients with SAB (576 with SOC, 162 with TM ID). No differences were observed in overall bundle adherence (SOC 86% vs TM 89%, P = .33). In addition, no significant differences resulted between groups for hospital mortality, 30-day SAB-related readmission, persistent bacteremia, and culture clearance. Groups did not differ in 30-day mortality when controlling for demographics, bacteremia source, and physiological measures with multivariable logistic regression.

Conclusions: Our findings provide evidence to support effective use of TM ID consultation and AMS-led care bundles for SAB management in resource-limited settings.

Keywords: Staphylococcus aureus; antimicrobial stewardship; bacteremia; infectious diseases; telemedicine.