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Infectious Disease Consultation in Postoperative Septic Patients: Impact on Outcomes

Cloe Nazeer1 Marisa Stratelak2, Bhavinkumar Dalal, M.D., PCCSM3

1M.D. Candidate, Oakland University William Beaumont School of Medicine, Rochester, MI

2M.D. Recipient, Oakland University William Beaumont School of Medicine, Rochester, MI

3Department of Critical Care and Pulmonology, Corewell Health William Beaumont University Hospital

increased complications and long-term morbidity.

6

  • Infectious disease (ID) consultation in sepsis management has been linked to reduced mortality, mechanical

ventilation, hospital stay, costs, and antibiotic duration.

7,8

Close collaboration and timely consultation between the primary and ID teams are key to improved outcomes.7,9

  • Prior studies highlight the benefits of collaboration between infectious disease (ID) and Intensive Care Unit (ICU) teams,10,11 but this has not been specifically examined in postoperative sepsis. Existing Surgical ICU (SICU) studies focus on pharmacist collaboration,

cost-effectiveness, or comparison of ID and surgical recommendations,12–14 leaving a gap regarding how direct ID–SICU collaboration influences outcomes.

Introduction

  • Sepsis is a progressive disease characterized by life-threatening organ dysfunction and the body’s

dysregulated response to infection. The triggers for sepsis can include bacteria, fungi, and viruses.

  • It may be difficult to identify septic patients because they can present with or without a fever, altered urine output, hypoxia, tachycardia, hypotension, feeling generally unwell, etc.1
  • The Surviving Sepsis Campaign encourages medical professionals to identify septic patients and start adequate antimicrobials as rapidly as possible, as the longer it takes for treatment and identification, the higher the mortality.2,3
  • Despite the current knowledge and methods of treatment, it is estimated that 5.3 million patients die of septic diseases worldwide.4
  • The American College of Chest Physicians and Society of Critical Care Medicine define postoperative sepsis as infection-related sepsis, severe sepsis, or septic shock occurring after surgery.5 Postoperative sepsis occurs in approximately 1.8% of surgical patients and is is linked to

Aims and Objectives

  • This study aimed to evaluate the relationship between infectious disease (ID) consultation and clinical outcomes in postoperative sepsis patients admitted to the surgical intensive care unit (SICU).
    • Specifically, we sought to assess whether the presence of an ID consult was associated with differences in SICU length of stay, mortality, and the development of septic shock.

Methods

  • A retrospective chart review of the Electronic Medical Record (EMR), Epic, used by Corewell Health Royal Oak was completed. Data was securely stored and included adult patients admitted to the SICU for a surgical procedure between January 1 and December 31, 2019, who developed sepsis.
  • Variables collected included ID consultation status, SICU length of stay, in-hospital mortality, and development of septic shock.
    • Demographics (age, sex, race) were recorded for context and generalizability.
  • Patients with informal ID consultations (undocumented recommendations) were excluded.
  • For patients with multiple SICU transfers, total SICU time was aggregated.
  • Death was defined as in-hospital death or discharge to hospice with a terminal prognosis.
  • Two-sample t-tests compared quantitative variables (e.g., age, SICU LOS), and chi-square tests were used for categorical variables (sex, race, mortality, septic shock).
  • SICU Length of Stay: Patients who received an ID consultation had a significantly longer average SICU stay (307.3 vs. 214.6 hours, p = 0.0451).
  • In-Hospital Mortality: Mortality was slightly higher among patients with an ID consult (38.2%) compared to those without (31.1%), though not statistically significant (p = 0.2110).
  • Septic Shock: Rates of septic shock were similar between groups (81.6% vs. 83.5%, p = 0.6736).
  • Age: Patients who received an ID consult were significantly younger on average (64.1 vs. 70.1 years, p = 0.0012).

Acknowledgements

I would like to thank Dr. Bhavinkumar Dalal for his clinical guidance and mentorship throughout this project. Special thanks to Michelle Jankowski for her expertise in statistical analysis and data interpretation. I also thank Marisa Stratelak for conducting a related MICU chart review, which will serve as a valuable comparison in future collaborative work on ID consultation practices.

Results

  • A total of 320 postoperative SICU patients with sepsis were included; 217 (67.8%) received an ID consultation and 103 (32.2%) did not.
  • This study compared SICU length of stay, age, sex, race, in-hospital mortality, and septic shock.
  • Continuous variables were summarized as mean (SD), median, and range, while categorical variables were reported as counts and percentages.

1.

References

Hunt A. Sepsis: an overview of the signs, symptoms, diagnosis, treatment and pathophysiology. Emerg Nurse. 2019;27(5):32-41.

doi:10.7748/en.2019.e1926

  1. Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181-1247. doi:10.1007/s00134-021-06506-y
  2. Garnacho-Montero J, Ortiz-Leyba C, Herrera-Melero I, et al. Mortality and morbidity attributable to inadequate empirical antimicrobial therapy in patients admitted to the ICU with sepsis: a matched cohort study. J Antimicrob Chemother. 2008;61(2):436-441. doi:10.1093/jac/dkm460
  3. Fleischmann C, Scherag A, Adhikari NK, et al. Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations. Am J Respir Crit Care Med. 2016;193(3):259-272. doi:10.1164/rccm.201504-0781OC
  1. Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):1644-1655. doi:10.1378/chest.101.6.1644
  2. Plaeke P, De Man JG, Coenen S, Jorens PG, De Winter BY, Hubens G. Clinical- and surgery-specific risk factors for postoperative sepsis: a systematic review and meta-analysis of over 30 million patients. Surg Today. 2020;50(5):427-439. doi:10.1007/s00595-019-01827-4

7. Raineri E, Pan A, Mondello P, Acquarolo A, Candiani A, Crema L. Role of the infectious diseases specialist consultant on the appropriateness of antimicrobial therapy prescription in an intensive care unit. Am J Infect Control. 2008;36(4):283-290. doi:10.1016/j.ajic.2007.06.009

8. Wolf S, Leitritz L, Rupp C, Schlöndorff D, Bogner JR. Cost reduction after introduction of a multidisciplinary infectious disease service at a German university hospital. Infection. 2000;28(6):379-383. doi:10.1007/s150100070009

  1. Esposito S, Leone S. Antimicrobial treatment for Intensive Care Unit (ICU) infections including the role of the infectious disease specialist. Int J Antimicrob Agents. 2007;29(5):494-500. doi:10.1016/j.ijantimicag.2006.10.017
  2. Al-Tawfiq JA. The pattern and impact of infectious diseases consultation on antimicrobial prescription. J Glob Infect Dis. 2013;5(2):45-48. doi:10.4103/0974-777X.112266
  3. Madaline T, Wadskier Montagne F, Eisenberg R, et al. Early Infectious Disease Consultation Is Associated With Lower Mortality in Patients With Severe Sepsis or Septic Shock Who Complete the 3-Hour Sepsis Treatment Bundle. Open Forum Infect Dis. 2019;6(10):ofz408. Published 2019 Oct 31. doi:10.1093/ofid/ofz408
  4. Ramanathan R, Leavell P, Mays C, Duane TM. Impact of Sepsis on Surgical Outcomes. Surg Infect (Larchmt). 2015;16(4):405-409. doi:10.1089/sur.2014.063
  5. Gorecki PJ, Schein M, Mehta V, Wise L. Surgeons and infectious disease specialists: different attitudes towards antibiotic treatment and prophylaxis in common abdominal surgical infections. Surg Infect (Larchmt). 2000;1(2):115-126. doi:10.1089/109629600321155
  6. Schmid S, Schlosser S, Gülow K, Pavel V, Müller M, Kratzer A. Interprofessional Collaboration between ICU Physicians, Staff Nurses, and Hospital Pharmacists Optimizes Antimicrobial Treatment and Improves Quality of Care and Economic Outcome. Antibiotics (Basel). 2022;11(3):381. Published 2022 Mar 13. doi:10.3390/antibiotics11030381

Conclusions

  • ID consultation was associated with a significantly longer SICU stay, likely reflecting use in more complex or prolonged cases rather than a causal effect.
  • Patients who received an ID consult were younger by about five years; however, this difference may suggest variation in treatment goals or care intensity among older patients.
  • No significant differences were observed in mortality or incidence of septic shock.
  • Findings should be interpreted cautiously given the retrospective design, small sample size, and potential confounders.
  • Future prospective studies should explore the timing and indications for ID consultation and its impact on outcomes in postoperative sepsis.