Association of Infectious Diseases Consultation with Long-term Postdischarge Outcomes among Patients with Staphylococcus aureus Bacteremia

Abstract

Importance: Staphylococcus aureus bacteremia (SAB) is common and associated with poor long-term outcomes. Previous studies have demonstrated an association between infectious diseases (ID) consultation and improved short-term (ie, within 90 days) outcomes for patients with SAB, but associations with long-term outcomes are unknown. Objective: To investigate the association of ID consultation with long-term (ie, 5 years) postdischarge outcomes among patients with SAB. Design, Setting, and Participants: This cohort study included all patients (N = 31002) with a first episode of SAB who were discharged alive from 116 acute care units of the nationwide Veterans Health Administration where ID consultation was offered. Data were collected from January 2003 to December 2014, with follow-up through September 30, 2018. Data analysis was conducted from February to December 2019. Exposures: Infectious diseases consultation during the index hospital stay. Main Outcomes and Measures: The primary outcome was time to development of a composite event of all-cause mortality or recurrence of SAB within 5 years of discharge. As secondary outcomes, SAB recurrence and all-cause mortality with and without recurrence were analyzed while accounting for semicompeting risks. Results: The cohort included 31002 patients (30265 [97.6%] men; median [interquartile range] age at SAB onset, 64.0 [57.0-75.0] years). Among 31002 patients, there were 18794 (60.6%) deaths, 4772 (15.4%) SAB recurrences, and 20414 (65.8%) composite events during 5 years of follow-up; 12773 deaths (68.0%) and 2268 recurrences (47.5%) occurred more than 90 days after discharge. Approximately half of patients (15360 [49.5%]) received ID consultation during the index hospital stay; ID consultation was associated with prolonged improvement in the composite outcome (adjusted hazard ratio at 5 years, 0.71; 95% CI, 0.68-0.74; P