Clinical Infectious Diseases Advance Access published June 10, 2015
1
Start Smart with Antimicrobial Stewardship
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Silvia Corcione, Nicole Pagani, Nicola Forni, Giovanni Di Perri, Francesco G. De Rosa Department of Medical Sciences, University of Turin, Infectious Diseases Clinic at the Amedeo di Savoia Hospital; Corso Svizzera 164, 10139 Turin, Italy
Address for Correspondence: Francesco G. De Rosa, MD, Associate Professor, Infectious Diseases, Department of Medical Sciences, University of Turin, Italy, Ospedale Amedeo di Savoia, Corso Svizzera 164, 10149 Turin, tel.
an M pt ed ce Ac © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: [email protected].
Downloaded from http://cid.oxfordjournals.org/ at University of Otago on July 2, 2015
us
+39 011 4393979, fax. +39 011 4393996, [email protected]
2
Dear Editor, Bai et al. reported a lower in-hospital mortality in 847 patients with S. aureus bloodstream infections (SA-BSI) who received an Infectious Diseases (ID) consultation within 7 days of
cr ipt
blood culture collection compared to the other patients without ID consultation (21% Vs 29%; p=0.0451; HR 0.72; IC 95% 0.52-0.99) [1].
In a similar time frame (2005-2007) we retrospectively reviewed 289 patients with SA-BSI in a 1,200-bed hospital in Turin and studied the risk factors for mortality at 21 days after diagnosis. In our study, ID consultation was defined if written in the medical records at any time during
The WalkAway system (Siemens, Sacramento, California) was used for isolates identification and antimicrobial susceptibility testing. Continuous variables were compared with Student t test
an
or the Mann-Whitney U test (for non-normally distributed variables). Categorical variables were evaluated with the χ2 or two-tailed Fisher exact test. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for all associations that emerged. Two-tailed tests were used to
M
determine statistical significance; a P value of 60 year old
47 (83.9)
143 (61.9)
0.002
NS
CVC removal
7 (12.5)
75 (32.5)
0.0001
NS
HCA-infection
24 (42.9)
57 (24.9)
0.0075
NS
Charlson index Score (+ SD) ID consult
4.50 (±2.13)
3.31 (±2.15)
0.0003
NS
3 (5.5)
44 (18.9)
0.012
0.172 (0.031-0.951)
Severe sepsis
44 (78.6)
36 (15.9)
0.0001
3.55 (1.176-10.796)
Septic shock
38 (67.9)
6 (2.64)
0.0001
46.536 (9.549-226.78)
Admission < 6 months before BSI
37 (68.5)
119 (52.2)
0.003
3.370 (1.052-10.796)
Ac
ce
pt ed
M
an
us
Survivors (n=233)
Downloaded from http://cid.oxfordjournals.org/ at University of Otago on July 2, 2015
Non survivors (n=56)
Variable n (%)
1
Start Smart with Antimicrobial Stewardship
cr ipt
Silvia Corcione, Nicole Pagani, Nicola Forni, Giovanni Di Perri, Francesco G. De Rosa Department of Medical Sciences, University of Turin, Infectious Diseases Clinic at the Amedeo di Savoia Hospital; Corso Svizzera 164, 10139 Turin, Italy
Address for Correspondence: Francesco G. De Rosa, MD, Associate Professor, Infectious Diseases, Department of Medical Sciences, University of Turin, Italy, Ospedale Amedeo di Savoia, Corso Svizzera 164, 10149 Turin, tel.
an M pt ed ce Ac © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: [email protected].
Downloaded from http://cid.oxfordjournals.org/ at University of Otago on July 2, 2015
us
+39 011 4393979, fax. +39 011 4393996, [email protected]
2
Dear Editor, Bai et al. reported a lower in-hospital mortality in 847 patients with S. aureus bloodstream infections (SA-BSI) who received an Infectious Diseases (ID) consultation within 7 days of
cr ipt
blood culture collection compared to the other patients without ID consultation (21% Vs 29%; p=0.0451; HR 0.72; IC 95% 0.52-0.99) [1].
In a similar time frame (2005-2007) we retrospectively reviewed 289 patients with SA-BSI in a 1,200-bed hospital in Turin and studied the risk factors for mortality at 21 days after diagnosis. In our study, ID consultation was defined if written in the medical records at any time during
The WalkAway system (Siemens, Sacramento, California) was used for isolates identification and antimicrobial susceptibility testing. Continuous variables were compared with Student t test
an
or the Mann-Whitney U test (for non-normally distributed variables). Categorical variables were evaluated with the χ2 or two-tailed Fisher exact test. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for all associations that emerged. Two-tailed tests were used to
M
determine statistical significance; a P value of 60 year old
47 (83.9)
143 (61.9)
0.002
NS
CVC removal
7 (12.5)
75 (32.5)
0.0001
NS
HCA-infection
24 (42.9)
57 (24.9)
0.0075
NS
Charlson index Score (+ SD) ID consult
4.50 (±2.13)
3.31 (±2.15)
0.0003
NS
3 (5.5)
44 (18.9)
0.012
0.172 (0.031-0.951)
Severe sepsis
44 (78.6)
36 (15.9)
0.0001
3.55 (1.176-10.796)
Septic shock
38 (67.9)
6 (2.64)
0.0001
46.536 (9.549-226.78)
Admission < 6 months before BSI
37 (68.5)
119 (52.2)
0.003
3.370 (1.052-10.796)
Ac
ce
pt ed
M
an
us
Survivors (n=233)
Downloaded from http://cid.oxfordjournals.org/ at University of Otago on July 2, 2015
Non survivors (n=56)
Variable n (%)
