Impact of infectious diseases consultation among patients with infections caused by gram-negative rod bacteria: a systematic literature review and meta-analysis

Figures & data

Figure 1. Forest plots of the associations between infectious diseases consultation and mortality among patients with infections due to Gram-negative rod bacteria. CI: confidence interval; IDC: infectious diseases consultation; IV: inverse variance weighting; NIDC: non-infectious diseases consultation; SE: standard error.

Table 1. Summary of the six studies included in the meta-analysis.

First author/publication year/location	Setting	Study design/Study population	Adjustment for confounders	Study period	Characteristic of included patients	Source of infection	GNR species	Outcome	D&B score
Chesdachai [4]/ 2020/Minnesota, US	Single academic centre	Retrospective cohort study/58 patients with P.aeruginosa bacteraemia	Multivariable Cox proportional hazards regression analysis	3 years	Adult 20.7% Malignancy	Unknown Bacteraemia 100%	P.aeruginosa 100%	58.6% received IDC. Three-month mortality was 44.8% in total. Adjusted HR of NIDC was 3.2 (95%CI: 1.4–7.3).	20
Chiong [5]/2021/ NT 0871, Australia	Single academic centre	Retrospective cohort study/128 cases of P.aeruginosa bacteraemia	Multivariate analysis	18 years and 7 months	Adult, Median age 68 years 17.2% DM 19.5% CKD 11.7% Cirrhosis 67.2% Immunocompromised 57.8% Malignancy 39.1% Community-onset 49.2% ICU admission 60.9% CCI > = 5	UTI 14.1% Pneumonia 15.6% Line-associated 25.0% SSTI 10.2% Other 3.1% Unknown 32.0% Bacteraemia 100%	P.aeruginosa 100% (carbapenem-resistant 3.1%, ciprofloxacin-resistant 3.9%, MDR 1.6%, XDR 0.78%)	71.1% received IDC. Thirty-day mortality was 24.2% in total. Adjusted OR of NIDC was 7.84 (95%CI: 2.95–20.86). Mean hospital length of stay was 16.7 days in IDC, 12.9 days in NIDC. Appropriate therapy was 73.6% in IDC, 56.8% in NIDC.	21
Khawcharoenporn [6]/ 2016/Pathumthani, Thailand	Single community hospital	Retrospective cohort study/ 136 patients diagnosed with XDR P.aeruginosa pneumonia	Multivariate analysis	6 years	Adult, Median age 78 years 42.6% DM 13.2% CKD 5.9% Chronic liver disease 8.8% Malignancy 36.8% Community-onset Median APACHE II 16	Pneumonia 100%	P.aeruginosa 100% (XDR 100%)	72.1% received IDC. 28-day mortality was 45.6% in total. Adjusted OR of NIDC was 10.93 (95%CI: 3.38–35.37).	22
Kim [7]/ 2018/ Busan, Korea	Single academic centre	Retrospective cohort study/ 161 patients with MDR bacteraemia	Multivariate Cox regression analysis	5 years	Adult 100% Mechanical ventilation 100% ICU admission	Unknown Bacteraemia 100%	E.coli 9.0% (ESBL 100%) K.pneumoniae 18.0% (ESBL 100%) A.baumanii 59.0% (carbapenem-resistant 100%) P.aeruginosa 5.0% (carbapenem-resistant 100%)	59.6% received IDC. 28-day mortality was 52.2% in total. Adjusted HR of IDC was 0.180 (95%CI: 0.097–0.333).	21
Oommen [8]/2019 /New York, US	Single community hospital	Retrospective cohort study/ 90 patients with antibiotic-resistant Gram-negative bacteria	Multivariate analysis	9 years	Adult Hemodialysis 100%	UTI 29.5% Bacteraemia 100%	K.pneumoniae 42.2%	30-day mortality was 38.5% in total. Adjusted OR of IDC was 0.13 (95%CI: 0.05–0.36).	18
Tang [9]/2017 Chengdu, China	Single academic centre	Retrospective cohort study/ 677 in patients with GNR bacteraemia	Multivariable logistic regression analysis	1 year	Adult	Unknown Bacteraemia 100%	E. coli 48.2% E.cloacae 6.4% K.pneumoniae 20.2% Acinetobacter spp. 9.0% P.aeruginosa 5.2%	41.2% received IDC. In-hospital mortality was 15.7% in total. Adjusted HR of IDC was 0.331.	20

APACHE: Acute Physiologic Assessment and Chronic Health Evaluation; CCI: Charlson Comorbidity Index; CI: confidence interval; CKD: chronic kidney disease; DM: diabetes mellitus; D&B score: Downs and Black score; ESBL: extended-spectrum β-lactamase; GNR: Gram-negative rod; HR: hazard ratio; ICU: intensive care unit; IDC: infectious diseases consultation; MDR: multidrug-resistant; NIDC: no infectious diseases consultation; OR: odds ratio; SSTI: skin and soft tissue infection; US: the United States of America; UTI: urinary tract infection; XDR: extensively drug-resistant.

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