2026 Southeastern Residency Conference

Title:
Treatment of Staphylococcus Aureus Bacteremia and the Impact of Infectious Disease Consultation

Authors:
Westley Eccles, Stephen Eure, Doug Carroll

Practice Site:
DCH Regional Medical Center-Tuscloosa, AL

Background: Staphylococcus aureus (S. aureus) remains a highly virulent pathogen causing infections worldwide. The pathogen frequently invades into the bloodstream to cause S. aureus bacteremia, which currently has an in-hospital mortality range of 10% to 30%. The Infectious Diseases Society of America (IDSA) guidelines on methicillin-resistant S. aureus (MRSA) remain an important backbone on proper management of S. aureus bacteremia. The IDSA guidelines outline antibiotic selection, classification, and duration of therapy, as well as recommended additional tests to manage the infection. These guidelines are still commonly followed to this date, with some notable differences in current best practice. It is highly important that patients receive optimal antibiotics and proper duration of antibiotic treatment to improve outcomes and reduce mortality. Other research projects have been conducted to compare patient outcomes when an infectious diseases (ID) specialist is directly involved in the management of S. aureus bacteremia. These studies suggest an improvement in both guideline-adherent management of the infection and a reduction in patient mortality. This project aims to assess the overall performance in managing S. aureus bacteremia in our facility, with a comparison between two groups (ID consultation versus no ID consultation).

Methodology: This study was a retrospective chart review of patients ≥18 years of age with positive blood cultures for either methicillin-sensitive S. aureus (MSSA) or MRSA between January 2024 to June 2025. A total of 140 patients were identified within our time period and screened for inclusion. After a chart review to confirm eligibility, 99 patients were included in the project. These patients were divided based on presence of ID consultation, where 42 patients received an ID consult and 57 patients did not receive an ID consult. Individual elements of performance (i.e., antibiotic selection, repeat blood cultures, echocardiography, and duration of therapy) were created to assess patient care based on the standard set by current practice and guidelines. Outcomes were compared between patients who had ID specialist consultation to those without ID specialist consultation. The primary outcome was a composite of all elements of performance, where compliance with all elements of performance was required to meet the primary outcome. Additional secondary outcomes included each individual element of performance, inpatient mortality, average duration of therapy, and hospital readmissions within 30 days, due to infectious process.

Results: Thirty-two (76%) patients with ID consult met the primary outcome compared to twenty-two (39%) patients without ID consult. Secondary outcomes included each individual element of performance alone. For ID consult, each individual element of performance was met as follows: thirty-five (83%) patients for antibiotic selection; Forty-one (98%) for repeat blood cultures; Forty-one (98%) for echocardiography; thirty-eight (91%) for guideline-compliant therapy. For no ID consultation, each individual element of performance was met as follows: forty-two (74%) patients for antibiotic selection; forty-nine (86%) for repeat blood cultures; Forty-four (77%) for echocardiography; thirty-four (60%) for guideline-compliant therapy. Ultimately, there was greater adherence to all elements of performance in the group of patients that had an ID specialist onboard in their care.

Conclusions: Adherence to current guidelines and best practice was more commonly seen in patients with an ID specialist onboard. Overall, ID specialist involvement improved the appropriate management of patients diagnosed with S. aureus bacteremia.