Improving patient care for antibiotic-resistant infections
Dr. Andrew Morris, Medical Director, Antimicrobial Stewardship Program
One of the most significant issues in hospitals around the world today is the rise of antibiotic-resistant infections and the associated high mortality rates. The World Health Organization, Canada’s Auditor-General and the U.S. Centres for Disease Control and Prevention have all delivered strong warnings about the risk that these infections pose to patient safety.
The Mount Sinai Hospital-University Health Network Antimicrobial Stewardship Program (MSH-UHN ASP) has researched and implemented a number of new practices to improve prevention, treatment and outcomes for patients, such as more efficient and safe use of antibiotics.
Now, a new study by a team of clinicians led by Dr. Andrew Morris, Medical Director of the program, and Dr. Chaim Bell, MSH-UHN ASP’s Research Director, in the journal Clinical Infectious Diseases, found that consulting an Infectious Disease Specialist for each individual case with a common bloodstream infection was associated with an approximately 30 per cent increase in in-hospital survival rates, and up to three fewer days in the hospital. The study, one of the largest on this topic, was designated as the journal’s Editor’s Choice for May 2015.
Researchers examined the records of 847 patients infected by the bacterium Staphylococcus aureus (SAB), which has a mortality rate of 25 per cent, at six hospitals across the Greater Toronto Area over a three-year period. Sixty per cent of these patients received a consultation from an infectious disease physician.
“Basically, the study showed that treatment and outcomes were better across the board for patients who received an infectious disease physician consult,” said Dr. Bell. “For example, about 68 per cent of surviving patients who received consults were given the optimal duration of antibiotic therapy, 14 per cent more than those who did not receive such consultations.”
Translating research to action
As a result of the study’s findings, both Mount Sinai Hospital, part of Sinai Health System, and University Health Network have implemented a policy requiring an infectious disease consult in all cases of SAB infection.
“In the fall, we will look at the initial findings to see if the mandatory infectious disease consult policy delivers the results we anticipated, based on our study and those previously published,” said Dr. Morris. “We are optimistic that this change will help us deliver the best care to our patients.”
The MSH-UHN Antimicrobial Stewardship Program plans to continue focusing on this important condition.
The study, ‘Impact of Infectious Disease Consultation on Quality of Care, Mortality and Length of Stay in Staphylococcus aureus Bacteremia: Results from a Large Multicenter Cohort Study’, was published in Clinical Infectious Diseases. This is one of a series of related papers from the MSH-UHN ASP published recently, including articles in the Journal of Antimicrobial Chemotherapy, and the American Journal of Infection Control.
About Mount Sinai Hospital
Mount Sinai Hospital, part of the Sinai Health System, is as an internationally recognized 442-bed acute care academic health sciences centre affiliated with the University of Toronto that is dedicated to delivering the best medicine and best patient experience. It is focused on excellence in patient and family-centred care, innovative education and leading-edge research. Clinical strengths include women’s and infants’ health, chronic disease management, specialized cancer care, emergency medicine, and geriatrics. The hospital has been designated with Exemplary Status from Accreditation Canada and every aspect of patient care is anchored in a rigorous quality plan and monitoring of safety and quality goals. Mount Sinai’s Lunenfeld-Tanenbaum Research Institute ranks in the top ten biomedical research institutes in the world. The Hospital was recently named the first hospital in Canada to receive Magnet® status for nursing excellence and patient care. The Hospital is considered to be a top employer in Canada, receiving multiple awards for its employment and culture centred programs. In 2015, Mount Sinai Hospital joined with Bridgepoint Active Healthcare, Circle of Care, and Lunenfeld-Tanenbaum Research Institute to form the Sinai Health System, with the goal of creating a premier exemplar of an integrated health system that provides better, more coordinated care for patients with the highest needs. www.mountsinai.ca
About University Health Network
University Health Network consists of Toronto General and Toronto Western Hospitals, Princess Margaret Cancer Centre, and Toronto Rehabilitation Institute. The scope of research and complexity of cases at University Health Network has made it a national and international source for discovery, education and patient care. It has the largest hospital-based research program in Canada, with major research in cardiology, transplantation, neurosciences, oncology, surgical innovation, infectious diseases, genomic medicine and rehabilitation medicine. University Health Network is a research hospital affiliated with the University of Toronto. www.uhn.ca
