Infectious disease consultation for Staphylococcus aureus bacteremia – A systematic review and meta-analysis

• 1st meta-analysis on the impact of IDC for patients with SAB.
• 17 studies with a total of 4860 patient were included.
• IDC reduces 30 & 90 day mortality significantly.
• IDC improves management of SAB significantly.
• Cluster-randomized trials are needed to confirm these findings.

SummaryObjectiveMortality and morbidity of Staphylococcus aureus bacteremia (SAB) still remains considerably high. We aimed to evaluate the impact of infectious disease consultation (IDC) on the management and outcomes of patients with SAB.MethodsWe systematically searched 3 publication databases from inception to 31st May 2015 and reference lists of identified primary studies.ResultsOur search returned 2874 reports, of which 18 fulfilled the inclusion criteria, accounting for 5337 patients. Overall 30-day mortality was 19.95% [95% CI 14.37–27.02] with a significant difference in favour of the IDC group (12.39% vs 26.07%) with a relative risk (RR) of 0.53 [95% CI 0.43–0.65]. 90-day mortality and relapse risk for SAB were also reduced significantly with RRs of 0.77 [95% CI 0.64–0.92] and 0.62 [95% CI 0.39–0.99], respectively. Both, the appropriateness of antistaphylococcal agent and treatment duration was improved by IDC (RR 1.14 [95% CI 1.08–1.20] and 1.85 [95% CI 1.39–2.46], respectively). Follow-up blood cultures and echocardiography were performed more frequently following IDC (RR 1.35 [95% CI 1.25–1.46] and 1.98 [95% CI 1.66–2.37], respectively).ConclusionsEvidence-based clinical management enforced by IDC may improve outcome of patients with SAB. Well-designed cluster-randomized controlled trials are needed to confirm this finding from observational studies.