Clinical Outcomes of Staphylococcus aureus Bacteremia Following Introduction of Mandatory Infectious Disease Specialist Consultation: A Retrospective 12-Month Study
Bibliographic record
Abstract
Background. Staphylococcus aureus bacteremia (SAB) leads to high morbidity and mortality in hospital. We will investigate if mandatory infectious disease (ID) consultation as a hospital policy leads to improved clinical outcomes in patients with Staphylococcus aureus bacteremia (SAB). Methods. A pre- and post-intervention observational study compared process and outcome measures after a quality-improvement intervention. Pre-intervention population consisted of two subsets at 3 academic hospitals from 2007 to 2010: one group that received infectious disease consultation after positive S. aureus blood culture and the other group that did not. Intervention was implementation of mandatory ID consultation and SAB protocol for patients ≥18 years of age with ≥1 positive blood culture for S. aureus. Post-intervention population were patients with positive S. aureus culture between December 2014 and November 2015. Patients were excluded if within 2 days of blood culture they: died, were deemed palliative, or left against medical advice. Electronic medical records were assessed using a standardized data collection form. Results. In the pre-intervention population, 273/411 (66%) received ID consultations versus 144/411 (35%) who did not. In the post-intervention group, 216 patients with Staphylococcus aureus bacteremia were identified, of which 209 (96.8%) received ID consult. The pre-intervention group had an in-hospital mortality rate of 23% versus the cumulative in-hospital mortality among the 3 sites was 42/216 (19.4%). After the intervention, there was increased use of process measures, notably echocardiography. In the pre-intervention cohorts, 73% of IDC and 56% of NIDC received echocardiography versus the post-intervention group, in which 200/216 (92.6%) received echocardiography. Mortality by Site Conclusion. This study demonstrates that mandatory ID consultation for S. aureus bacteremia resulted in improved adherence to certain process measures; however, there are no significant improvements in mortality. Disclosures. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".