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A Fully Integrated Infectious Diseases and Antimicrobial Stewardship Telehealth Service Improves Staphylococcus aureus Bacteremia Bundle Adherence and Outcomes in 16 Small Community Hospitals

BACKGROUND: Infectious diseases (ID) and antimicrobial stewardship (AS) improve Staphylococcus aureus bacteremia (SAB) outcomes. However, many small community hospitals (SCHs) lack on-site access to these services, and it is not known if ID telehealth (IDt) offers the same benefit for SAB. We evalua...

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Autores principales: Veillette, John J, May, Stephanie S, Gabrellas, Alithea D, Gelman, Stephanie S, Albritton, Jordan, Lyons, Michael D, Stenehjem, Edward A, Webb, Brandon J, Dalto, Joseph D, Throneberry, S Kyle, Stanfield, Valoree, Grisel, Nancy A, Vento, Todd J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9645643/
https://www.ncbi.nlm.nih.gov/pubmed/36381624
http://dx.doi.org/10.1093/ofid/ofac549
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author Veillette, John J
May, Stephanie S
Gabrellas, Alithea D
Gelman, Stephanie S
Albritton, Jordan
Lyons, Michael D
Stenehjem, Edward A
Webb, Brandon J
Dalto, Joseph D
Throneberry, S Kyle
Stanfield, Valoree
Grisel, Nancy A
Vento, Todd J
author_facet Veillette, John J
May, Stephanie S
Gabrellas, Alithea D
Gelman, Stephanie S
Albritton, Jordan
Lyons, Michael D
Stenehjem, Edward A
Webb, Brandon J
Dalto, Joseph D
Throneberry, S Kyle
Stanfield, Valoree
Grisel, Nancy A
Vento, Todd J
author_sort Veillette, John J
collection PubMed
description BACKGROUND: Infectious diseases (ID) and antimicrobial stewardship (AS) improve Staphylococcus aureus bacteremia (SAB) outcomes. However, many small community hospitals (SCHs) lack on-site access to these services, and it is not known if ID telehealth (IDt) offers the same benefit for SAB. We evaluated the impact of an integrated IDt service on SAB outcomes in 16 SCHs. METHODS: An IDt service offering IDt physician consultation plus IDt pharmacist surveillance was implemented in October 2016. Patients treated for SAB in 16 SCHs between January 2009 and August 2019 were identified for review. We compared SAB bundle adherence and outcomes between patients with and without an IDt consult (IDt group and control group, respectively). RESULTS: A total of 423 patients met inclusion criteria: 157 in the IDt group and 266 in the control group. Baseline characteristics were similar between groups. Among patients completing their admission at an SCH, IDt consultation increased SAB bundle adherence (79% vs 23%; odds ratio [OR], 16.9; 95% CI, 9.2–31.0). Thirty-day mortality and 90-day SAB recurrence favored the IDt group, but the differences were not statistically significant (5% vs 9%; P = .2; and 2% vs 6%; P = .09; respectively). IDt consultation significantly decreased 30-day SAB-related readmissions (9% vs 17%; P = .045) and increased length of stay (median [IQR], 5 [5–8] days vs 5 [3–7] days; P = .04). In a subgroup of SAB patients with a controllable source, IDt appeared to have a mortality benefit (2% vs 9%; OR, 0.12; 95% CI, 0.01–0.98). CONCLUSIONS: An integrated ID/AS telehealth service improved SAB management and outcomes at 16 SCHs. These findings provide important insights for other IDt programs.
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spelling pubmed-96456432022-11-14 A Fully Integrated Infectious Diseases and Antimicrobial Stewardship Telehealth Service Improves Staphylococcus aureus Bacteremia Bundle Adherence and Outcomes in 16 Small Community Hospitals Veillette, John J May, Stephanie S Gabrellas, Alithea D Gelman, Stephanie S Albritton, Jordan Lyons, Michael D Stenehjem, Edward A Webb, Brandon J Dalto, Joseph D Throneberry, S Kyle Stanfield, Valoree Grisel, Nancy A Vento, Todd J Open Forum Infect Dis Major Article BACKGROUND: Infectious diseases (ID) and antimicrobial stewardship (AS) improve Staphylococcus aureus bacteremia (SAB) outcomes. However, many small community hospitals (SCHs) lack on-site access to these services, and it is not known if ID telehealth (IDt) offers the same benefit for SAB. We evaluated the impact of an integrated IDt service on SAB outcomes in 16 SCHs. METHODS: An IDt service offering IDt physician consultation plus IDt pharmacist surveillance was implemented in October 2016. Patients treated for SAB in 16 SCHs between January 2009 and August 2019 were identified for review. We compared SAB bundle adherence and outcomes between patients with and without an IDt consult (IDt group and control group, respectively). RESULTS: A total of 423 patients met inclusion criteria: 157 in the IDt group and 266 in the control group. Baseline characteristics were similar between groups. Among patients completing their admission at an SCH, IDt consultation increased SAB bundle adherence (79% vs 23%; odds ratio [OR], 16.9; 95% CI, 9.2–31.0). Thirty-day mortality and 90-day SAB recurrence favored the IDt group, but the differences were not statistically significant (5% vs 9%; P = .2; and 2% vs 6%; P = .09; respectively). IDt consultation significantly decreased 30-day SAB-related readmissions (9% vs 17%; P = .045) and increased length of stay (median [IQR], 5 [5–8] days vs 5 [3–7] days; P = .04). In a subgroup of SAB patients with a controllable source, IDt appeared to have a mortality benefit (2% vs 9%; OR, 0.12; 95% CI, 0.01–0.98). CONCLUSIONS: An integrated ID/AS telehealth service improved SAB management and outcomes at 16 SCHs. These findings provide important insights for other IDt programs. Oxford University Press 2022-10-14 /pmc/articles/PMC9645643/ /pubmed/36381624 http://dx.doi.org/10.1093/ofid/ofac549 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Major Article
Veillette, John J
May, Stephanie S
Gabrellas, Alithea D
Gelman, Stephanie S
Albritton, Jordan
Lyons, Michael D
Stenehjem, Edward A
Webb, Brandon J
Dalto, Joseph D
Throneberry, S Kyle
Stanfield, Valoree
Grisel, Nancy A
Vento, Todd J
A Fully Integrated Infectious Diseases and Antimicrobial Stewardship Telehealth Service Improves Staphylococcus aureus Bacteremia Bundle Adherence and Outcomes in 16 Small Community Hospitals
title A Fully Integrated Infectious Diseases and Antimicrobial Stewardship Telehealth Service Improves Staphylococcus aureus Bacteremia Bundle Adherence and Outcomes in 16 Small Community Hospitals
title_full A Fully Integrated Infectious Diseases and Antimicrobial Stewardship Telehealth Service Improves Staphylococcus aureus Bacteremia Bundle Adherence and Outcomes in 16 Small Community Hospitals
title_fullStr A Fully Integrated Infectious Diseases and Antimicrobial Stewardship Telehealth Service Improves Staphylococcus aureus Bacteremia Bundle Adherence and Outcomes in 16 Small Community Hospitals
title_full_unstemmed A Fully Integrated Infectious Diseases and Antimicrobial Stewardship Telehealth Service Improves Staphylococcus aureus Bacteremia Bundle Adherence and Outcomes in 16 Small Community Hospitals
title_short A Fully Integrated Infectious Diseases and Antimicrobial Stewardship Telehealth Service Improves Staphylococcus aureus Bacteremia Bundle Adherence and Outcomes in 16 Small Community Hospitals
title_sort fully integrated infectious diseases and antimicrobial stewardship telehealth service improves staphylococcus aureus bacteremia bundle adherence and outcomes in 16 small community hospitals
topic Major Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9645643/
https://www.ncbi.nlm.nih.gov/pubmed/36381624
http://dx.doi.org/10.1093/ofid/ofac549
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