P-44. Trend of Palliative Care Consult Among Patients with Staphylococcus aureus Bacteremia at a Mid-west Referral Center Between 2016 and 2018

TL;DR

This study examines how often palliative care is used in patients with Staphylococcus aureus bloodstream infections and finds it is associated with important care transitions.

Contribution

The study identifies predictors and outcomes of palliative care consultation in Staphylococcus aureus bacteremia patients.

Findings

Palliative care consultation was associated with shorter antibiotic use and increased documentation of care goals.

Older age and prolonged infection were linked to higher odds of palliative care consultation.

Many patients with SAB died without palliative care involvement, suggesting a need for earlier integration.

Abstract

Staphylococcus aureus bacteremia (SAB) remains a leading cause of bloodstream infection in both community and healthcare settings, with reported mortality rates ranging from 10% to 30%. This study aimed to characterize the frequency, predictors, and clinical impact of palliative care consultation (PCC) in hospitalized patients with SAB.Figure 1.Distribution of Palliative Care Consults in hospitalized Staphylococcus aureus bacteremia patientsFigure 2.Distribution of Staphylococcus aureus bacteremia patients during hospitalization

Distribution of Palliative Care Consults in hospitalized Staphylococcus aureus bacteremia patients

Distribution of Staphylococcus aureus bacteremia patients during hospitalization

We conducted a retrospective cohort study of adult and pediatric inpatients with SAB, defined by ≥1 positive blood culture for S. aureus, between January 1, 2016, and December 31, 2018. Baseline characteristics were compared between patients who did and did not receive PCC using chi-square, Fisher’s exact, and Wilcoxon rank-sum tests. Temporal trends, predictors of PCC, and associated outcomes were assessed using multivariable regression models. Survival was analyzed using Kaplan-Meier methods.

Among 479 patients with SAB, 89 (18.6%) received PCC. Although PCC use increased over time, the trend was not statistically significant. Goals-of-care (GoC) discussions were the most common indication. Independent predictors of PCC included older age (adjusted odds ratio [aOR], 1.03 per year; 95% CI, 1.02–1.05; P< 0.001) and prolonged bacteremia (aOR, 1.10 per day; 95% CI, 1.00–1.21; P=0.042). Female sex (aOR, 0.54; 95% CI, 0.29–0.97; P=0.043) and musculoskeletal/soft tissue source of infection (aOR, 0.35; 95% CI, 0.14–0.83; P=0.021) were associated with lower odds of PCC. PCC was associated with shorter antibiotic duration (aOR, 0.58; 95% CI, 0.55–0.61; P< 0.001), increased GoC documentation (aOR, 1369.48; 95% CI, 257.29–25,917.74; P< 0.001), and higher rates of transition to comfort care (aOR, 42.40; 95% CI, 19.96–98.50; P< 0.001) and hospice (aOR, 164.34; 95% CI, 26.55–360.32; P< 0.001). Median time from consultation to discharge was 4 days (IQR, 1–10), and was shorter among those who died in-hospital (2 vs. 8 days; P< 0.0001).

PCC was infrequently utilized among patients with SAB but strongly associated with care transitions and antimicrobial stewardship outcomes. A substantial proportion of patients died without PCC involvement. These findings highlight the need for earlier integration of palliative care in the management of SAB to support patient-centered care.

Paul G. Auwaerter, MD, Capricor: Board Member|Capricor: Stocks/Bonds (Public Company)|Johnson and Johnson: Stocks/Bonds (Public Company)|Pfizer: Grant/Research Support|Shionogi: Advisor/Consultant

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