Palliative care consultation in patients with Staphylococcus aureus bacteremia

Abstract

Background:

Palliative care consultation has shown benefits across a wide spectrum of diseases, but the utility in patients with Staphylococcus aureus bacteremia remains unclear despite its high mortality.

Aim:

To examine the frequency of palliative care consultation and factors associated with palliative care consult in Staphylococcus aureus bacteremia patients in the United States.

Design:

A population-based retrospective analysis using the Nationwide Inpatient Sample database in 2014, compiled by the Healthcare Costs and Utilization Project of the Agency for Healthcare Research and Quality.

Setting/subjects:

All inpatients with a discharge diagnosis of Staphylococcus aureus bacteremia (ICD-9-CM codes; 038.11 and 038.12).

Measurements:

Palliative care consultation was identified using ICD-9-CM code V66.7. Patients’ baseline characteristics and outcomes were compared between those with and without palliative care consult.

Results:

A total of 111,320 Staphylococcus aureus bacteremia admissions were identified in 2014. Palliative care consult was observed in 8140 admissions (7.3%). Palliative care consultation was associated with advanced age, white race, comorbidities, higher income, teaching/urban hospitals, Midwest region, Methicillin-resistant Staphylococcus aureus bacteremia and the lack of echocardiogram. Palliative care consult was also associated with shorter but more expensive hospitalizations. Crude mortality was 53% (4314/8140) among admissions with palliative care consult and 8% (8357/10,3180) among those without palliative care consult (p < 0.001).

Conclusions:

Palliative care consultation was infrequent during the management of Staphylococcus aureus bacteremia, and a substantial number of patients died during their hospitalizations without palliative care consult. Given the reported benefit in other medical conditions, palliative care consultation may have a role in Staphylococcus aureus bacteremia. Selecting patients who may benefit the most should be explored.

Keywords

palliative care consultation mortality staphylococcus aureus

Get full access to this article

View all access options for this article.

References

Austin

Sullivan

Macesic

, et al. Reduced mortality of Staphylococcus aureus bacteremia in a retrospective cohort study of 2139 patients: 2007–2015. Clin Infect Dis 2020; 70: 1666–1674.

Marra

Edmond

Forbes

, et al. Time to blood culture positivity as a predictor of clinical outcome of Staphylococcus aureus bloodstream infection. J Clin Microbiol 2006; 44: 1342–1346.

Lesens

Methlin

Hansmann

, et al. Role of comorbidity in mortality related to Staphylococcus aureus bacteremia: a prospective study using the Charlson weighted index of comorbidity. Infect Control Hosp Epidemiol 2003; 24: 890–896.

Gopal

Fowler

Jr Shah

, et al. Prospective analysis of Staphylococcus aureus bacteremia in nonneutropenic adults with malignancy. J Clin Oncol 2000; 18: 1110–1115.

Barkley

McCall

Maslow

, et al. Timing of palliative care consultation and the impact on thirty-day readmissions and inpatient mortality. J Palliat Med 2019; 22: 393–399.

Kelley

Morrison

RS.

Palliative care for the seriously ill. N Engl J Med 2015; 373: 747–755.

Harding

Palliative care as an essential component of the HIV care continuum. Lancet HIV 2018; 5: e524–e530.

Rush

Hertz

Bond

, et al. Use of palliative care in patients with end-stage COPD and receiving home oxygen: national trends and barriers to care in the United States. Chest 2017; 151: 41–46.

Ando

Adegbala

Uemura

, et al. Palliative care in ruptured aortic aneurysm in the United States: a retrospective analysis of nationwide inpatient sample database. Angiology 2020; 71: 633–640.

10.

NIS Description of Data Elements. Agency for healthcare research and quality, https://www.hcup-us.ahrq.gov/db/vars/hosp_bedsize/nisnote.jsp (2014, accessed 7 November 2020).

11.

Inagaki

Lucar

Blackshear

, et al. Methicillin-susceptible and methicillin-resistant Staphylococcus aureus bacteremia: nationwide estimates of 30-day readmission, in-hospital mortality, length of stay, and cost in the United States. Clin Infect Dis 2019; 69: 2112–2118.

12.

Klein

Jiang

Mojica

, et al. National costs associated with methicillin-susceptible and methicillin-resistant Staphylococcus aureus hospitalizations in the United States, 2010–2014. Clin Infect Dis 2019; 68: 22–28.

13.

Klein

Mojica

Jiang

, et al. Trends in methicillin-resistant Staphylococcus aureus hospitalizations in the United States, 2010–2014. Clin Infect Dis 2017; 65: 1921–1923.

14.

Qureshi

Adil

Suri

MF.

Rate of utilization and determinants of withdrawal of care in acute ischemic stroke treated with thrombolytics in USA. Med Care 2013; 51: 1094–1100.

15.

The United States Census Bureau. Census regions and divisions of the United States, https://www.census.gov/geographies/reference-maps/2010/geo/2010-census-regions-and-divisions-of-the-united-states.html (2010, accessed 2 February 2020).

16.

Temel

Greer

Muzikansky

, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010; 363: 733–742.

17.

Thomas

Jackson

Carlson

, et al. Communication differences between oncologists and palliative care clinicians: a qualitative analysis of early, integrated palliative care in patients with advanced cancer. J Palliat Med 2019; 22: 41–49.

18.

Ferrell

Temel

Temin

, et al. Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2017; 35: 96–112.

19.

Kourtis

Hatfield

Baggs

, et al. Vital signs: epidemiology and recent trends in methicillin-resistant and in methicillin-susceptible Staphylococcus aureus bloodstream infections—United States. MMWR Morb Mortal Wkly Rep 2019; 68: 214–219.

20.

Ando

Akintoye

Uemura

, et al. Palliative care referral in ST-segment elevation myocardial infarction complicated with cardiogenic shock in the United States. Heart Lung 2020; 49: 25–29.

21.

Murthy

Moradiya

Hanley

, et al. Palliative care utilization in nontraumatic intracerebral hemorrhage in the United States. Crit Care Med 2016; 44: 575–582.

22.

King

Doernberg

Miller

, et al. Patients’ experiences with Staphylococcus aureus and gram-negative bacterial bloodstream infections: a qualitative descriptive study and concept elicitation phase to inform measurement of patient-reported quality of life. Clin Infect Dis. Epub ahead of print 23 May 2020. DOI: 10.1093/cid/ciaa611.

23.

Honda

Krauss

Jones

, et al. The value of infectious diseases consultation in Staphylococcus aureus bacteremia. Am J Med 2010; 123: 631–637.

24.

Rieg

Peyerl-Hoffmann

De With

, et al. Mortality of S. aureus bacteremia and infectious diseases specialist consultation—a study of 521 patients in Germany. J Infect 2009; 59: 232–239.

25.

Blot

Vandewoude

Hoste

, et al. Outcome and attributable mortality in critically ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus. Arch Intern Med 2002; 162: 2229–2235.

26.

May

Normand

Cassel

, et al. Economics of palliative care for hospitalized adults with serious illness: a meta-analysis. JAMA Intern Med 2018; 178: 820–829.

27.

Kyeremanteng

Gagnon

Thavorn

, et al. The impact of palliative care consultation in the ICU on length of stay: a systematic review and cost evaluation. J Intensive Care Med 2018; 33: 346–353.

28.

Kanafani

Kourany

Fowler

Jr , et al. Clinical characteristics and outcomes of diabetic patients with Staphylococcus aureus bacteremia and endocarditis. Eur J Clin Microbiol Infect Dis 2009; 28: 1477–1482.