2026 Southeastern Residency Conference

Title: Tracking the Trends: Staphylococcus aureus Bacteremia Rates in a Rural, Not-for-Profit Hospital 
Authors: Natalie Ly, Heather Gibson, Allison Cid, Gretchen Arnoczy 
FirstHealth Moore Regional Hospital – Pinehurst, NC 
 
Background: Infectious Diseases (ID) consultation is associated with improved outcomes in Staphylococcus aureus bacteremia (SAB), yet access may be limited in community settings. This study evaluated SAB outcomes following interventions to increase ID consultation at a community health system. Interventions included increased ID availability for telemedicine consults, as well as a recommendation for ID consultation for all appropriate SAB cases. 

Methods: This retrospective chart review study utilized electronic medical records from FirstHealth patients with data collected from January 1, 2024 through January 31, 2025. All patients within the 4-hospital FirstHealth of the Carolinas system who had blood cultures positive for Staphylococcus aureus were evaluated. Patients were excluded if they met the following criteria: died or transitioned to comfort care within 3 days of positive blood culture, transferred to another institution, or were lost to follow-up. Patient characteristics and demographics were collected including age, sex, methicillin-resistant Staphylococcus aureus (MRSA), persistent bacteremia, persons who inject drugs (PWID), confirmed endocarditis, transthoracic echocardiogram (TTE), transesophageal echocardiogram (TEE), and ID consult status, as these are predictors of 6-month mortality for patients with SAB. The primary outcome studied was difference in 6-month mortality and recurrence rates, compared to rates observed within the hospital system during the COVID-19 pandemic. Secondary outcomes include differences in mortality or frequency of ID consults, particularly related to the implementation of ID telemedicine consults, as well as use of dalbavancin or oritavancin. 

Results: A total of 147 patients were included in this study. The 6-month mortality rate was 40/147 (27.2%), which was 5.9% lower than during the previous studied time frame; however, this was not statistically significant with a p-value of 0.25 (Relative Risk 0.82 [95% Confidence Interval 0.58-1.15]). Recurrence was defined as a return of SAB at least 2 weeks after resolution of the initial episode, as evidenced by documented negative blood cultures and improvement of clinical symptoms. The 6-month recurrence rate was 10/147 (6.8%), which was 2.5% lower than during the previous studied time frame. This was also a nonsignificant finding (Relative Risk 0.73 [95% Confidence Interval 0.34-1.56], p-value 0.42). The majority of patients 140/147 (95.2%) had an ID consult, as compared to 116/172 (67.4%) in the previous study. This 27.8% increase was statistically significant at a p-value of <0.001, with the rise in consult rates primary driven by telemedicine visits. There was also a higher incidence of cardiac imaging obtained and a trend toward shorter time to ID consult placed after positive blood culture. Utilization of long-acting lipoglycopeptides was low, as only 3 patients received dalbavancin and none received oritavancin.  
There are a number of factors that may have impacted the results of this study. Firstly, there were a small number of patients evaluated, which could make it more difficult to detect statistical significance when the study is not adequately powered. Furthermore, the population in this study included non-COVID patients, in contrast to the previous studied time period where patients had COVID-19 complicating their SAB. These patients may have differed in baseline illness severity, potentially biasing outcome comparisons.  

Conclusions: In this study, the expansion of ID access was associated with significantly higher ID consultation rates and favorable trends in 6-month mortality and recurrence rates among patients with SAB. These findings support the role of expanded ID access in improving SAB management within community health systems.