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Martin A, Ruch Y, Douiri N, Boyer P, Argemi X, Hansmann Y, Lefebvre N. Factors associated with treatment failure after advice from infectious disease specialists. Med Mal Infect 2019; 50:696-701. [PMID: 31812296 DOI: 10.1016/j.medmal.2019.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 01/30/2019] [Accepted: 11/06/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Risk factors associated with treatment failure after the infectious disease specialist's (IDS) advice remain unknown. We aimed to identify these risk factors. METHODS We included patients hospitalized in our tertiary care center who consulted an infectious disease specialist between January 2013 and April 2015. Treatment failure was defined by a composite criterion: signs of sepsis beyond Day 3, ICU admission, or death. Treatment success was defined by the patient's sustained clinical improvement. RESULTS A total of 240 IDS recommendations were made. Diagnosis was changed for 64 patients (26.7%) and 50 patients experienced treatment failure after the IDS advice. In multivariate analysis, compliance with the IDS advice was associated with a higher rate of success (OR=0.09, 95%CI [0.01-0.67]). Variables associated with treatment failure in the multivariate analysis were Charlson comorbidity score at admission (OR=1.24, 95%CI [1.03-1.50]), a history of infection or colonization with multidrug-resistant bacteria (OR=8.27, 95%CI [1.37-49.80]), and deterioration of the patient's status three days after the IDS advice (OR=12.50, 95%CI [3.16-49.46]). CONCLUSION Reassessing IDS recommendations could be interesting for specific patients to further adapt and improve them.
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Affiliation(s)
- A Martin
- Maladies infectieuses et tropicales, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
| | - Y Ruch
- Maladies infectieuses et tropicales, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - N Douiri
- Maladies infectieuses et tropicales, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - P Boyer
- Laboratoire de microbiologie, hôpitaux universitaires de Strasbourg, 3, rue Koeberlé, 67000 Strasbourg, France
| | - X Argemi
- Maladies infectieuses et tropicales, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - Y Hansmann
- Maladies infectieuses et tropicales, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - N Lefebvre
- Maladies infectieuses et tropicales, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
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Wee LE, Tan AL, Wijaya L, Chlebicki MP, Thumboo J, Tan BH. Timeliness of Infectious Diseases Referral and Inappropriate Antibiotic Usage Post-Referral in an Asian Tertiary Hospital. Trop Med Infect Dis 2019; 4:tropicalmed4040137. [PMID: 31752072 PMCID: PMC6958425 DOI: 10.3390/tropicalmed4040137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 11/16/2022] Open
Abstract
Infectious diseases (ID) specialists advise on complicated infections and are advocates for the interventions of antibiotic stewardship programs (ASP). Early referral to ID specialists has been shown to improve patient outcomes; however, not all referrals to ID specialists are made in a timely fashion. A retrospective cross-sectional study of all referrals to ID specialists in a Singaporean tertiary hospital was conducted from January 2016 to January 2018. The following quality indicators were examined: early referral to ID specialists (within 48 h of admission) and ASP intervention for inappropriate antibiotic usage, even after referral to ID specialists. Chi-square was used for univariate analysis and logistic regression for multivariate analysis. A total of 6490 referrals over the 2-year period were analysed; of those, 36.7% (2384/6490) were from surgical disciplines, 47.0% (3050/6490) were from medical disciplines, 14.2% (922/6490) from haematology/oncology and 2.1% (134/6490) were made to the transplant ID service. Haematology/oncology patients and older patients (aged ≥ 60 years) had lower odds of early referral to ID specialists but higher odds of subsequent ASP intervention for inappropriate antibiotic usage, despite prior referral to an ID specialist. Elderly patients and haematology/oncology patients can be referred to ID specialists earlier and their antimicrobial regimens further optimised, perhaps by fostering closer cooperation between ID specialists and primary physicians.
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Affiliation(s)
- Liang En Wee
- Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore
- Department of Infectious Diseases, Singapore General Hospital, Outram Road, Singapore 169608, Singapore; (L.W.); (M.P.C.); (B.H.T.)
- Correspondence: ; Tel.: +65-9677-7651
| | - Aidan Lyanzhiang Tan
- Preventive Medicine Residency, National University Health System, 1E Kent Ridge Rd, Singapore 119228, Singapore;
| | - Limin Wijaya
- Department of Infectious Diseases, Singapore General Hospital, Outram Road, Singapore 169608, Singapore; (L.W.); (M.P.C.); (B.H.T.)
| | - Maciej Piotr Chlebicki
- Department of Infectious Diseases, Singapore General Hospital, Outram Road, Singapore 169608, Singapore; (L.W.); (M.P.C.); (B.H.T.)
| | - Julian Thumboo
- Department of Rheumatology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore;
- Health Services Research Unit, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Ban Hock Tan
- Department of Infectious Diseases, Singapore General Hospital, Outram Road, Singapore 169608, Singapore; (L.W.); (M.P.C.); (B.H.T.)
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Kawamura I, Kurai H. Inpatient infectious disease consultations requested by surgeons at a comprehensive cancer center. Support Care Cancer 2015; 23:3011-4. [PMID: 25724410 DOI: 10.1007/s00520-015-2669-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/15/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study was to describe the value of infectious disease specialist consultations for surgeons at comprehensive cancer centers. METHODS A total of 151 cancer surgery inpatients were retrospectively assessed during a 12-month period. We focused on the characteristics of the infectious disease consultations from surgical departments: the referring surgical divisions, the referral phases, and the reasons for the infectious disease consultations. RESULTS Three-quarters of all consultation requests were made after the day of surgery. Approximately, 60 % of these requests were made within 30 days after surgery for cancer. The reasons for the infectious disease consultations could be classified into three categories: diagnosis and management (54 %), management of established infections (44 %), and surgical antimicrobial prophylaxis (3 %). The most requested reason for consultations was the diagnosis and management of fever or elevated inflammatory markers of unknown etiology. Among the management of established infections, the antimicrobial management of surgical site infections was most frequently requested. CONCLUSIONS Many surgeons would prefer infectious disease specialists to assume a more direct role in the care of difficult or perplexing cases (such as fevers of unknown origin) while also maintaining a traditional relationship in which the consultant recommends antimicrobial agents during a perioperative period. Particularly at cancer centers where oncology specialists account for a significant proportion of the providers, the knowledge and skill of infectious disease physicians are valued.
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Affiliation(s)
- Ichiro Kawamura
- Division of Infectious Diseases, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka Prefecture, 411-8777, Japan,
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Ingram P, Cheng A, Murray R, Blyth C, Walls T, Fisher D, Davis J. What do infectious diseases physicians do? A 2-week snapshot of inpatient consultative activities across Australia, New Zealand and Singapore. Clin Microbiol Infect 2014; 20:O737-44. [DOI: 10.1111/1469-0691.12581] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 01/23/2014] [Accepted: 01/28/2014] [Indexed: 11/29/2022]
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Pulcini C, Botelho-Nevers E, Dyar OJ, Harbarth S. The impact of infectious disease specialists on antibiotic prescribing in hospitals. Clin Microbiol Infect 2014; 20:963-72. [PMID: 25039787 DOI: 10.1111/1469-0691.12751] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Given the current bacterial resistance crisis, antimicrobial stewardship programmes are of the utmost importance. We present a narrative review of the impact of infectious disease specialists (IDSs) on the quality and quantity of antibiotic use in acute-care hospitals, and discuss the main factors that could limit the efficacy of IDS recommendations. A total of 31 studies were included in this review, with a wide range of infections, hospital settings, and types of antibiotic prescription. Seven of 31 studies were randomized controlled trials, before/after controlled studies, or before/after uncontrolled studies with interrupted time-series analysis. In almost all studies, IDS intervention was associated with a significant improvement in the appropriateness of antibiotic prescribing as compared with prescriptions without any IDS input, and with decreased antibiotic consumption. Variability in the antibiotic prescribing practices of IDSs, informal (curbside) consultations and the involvement of junior IDSs are among the factors that could have an impact on the efficacy of IDS recommendations and on compliance rates, and deserve further investigation. We also discuss possible drawbacks of IDSs in acute-care hospitals that are rarely reported in the published literature. Overall, IDSs are valuable to antimicrobial stewardship programmes in hospitals, but their impact depends on many human and organizational factors.
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Affiliation(s)
- C Pulcini
- Service de Maladies Infectieuses, CHU de Nancy, Nancy, France; Université de Lorraine, EA 4360 APEMAC, Nancy, France
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Yogarajah M, Mirfenderesky M, Ahmed T, Schon F. Consultant supervision of trainees seeing inpatient ward referrals - a cause for concern? Clin Med (Lond) 2014; 14:268-73. [PMID: 24889571 PMCID: PMC4952539 DOI: 10.7861/clinmedicine.14-3-268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The adequate supervision of trainee doctors seeing ward referrals is critical to the quality of patient care and medical training. This survey assessed the level and nature of supervision of trainees in neurology and comparable specialities. 123 neurology specialty registrars from nine deaneries across the UK and 81 dermatology, rheumatology and infectious disease specialty registrars from the London deanery completed the survey. Only 11% of first year neurology and 21% of first year non-neurology registrars reported that the most common method of supervision when seeing ward referrals was for consultants to see ward referrals with them. The remaining first year neurology and non-neurology registrars reported being primarily supervised by discussing cases with consultant (62% and 37% respectively) or being asked to contact a consultant if help was needed (35% and 42% respectively). The lack of adequate supervision of junior trainees seeing ward referrals has significant implications for both patient safety and training.
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Affiliation(s)
| | | | - Tazeen Ahmed
- Rheumatology Department, St George's Hospital, London, UK
| | - Fred Schon
- Neurology Department, St George's Hospital, London, UK
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Informal consultation at a teaching hospital infectious diseases department. Med Mal Infect 2014; 44:107-11. [PMID: 24612506 DOI: 10.1016/j.medmal.2014.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 09/26/2013] [Accepted: 01/28/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Informal consultations for advice in the infectious diseases department (IDD) induce a significant workload for physicians. Our aim was to retrospectively quantify and describe this activity in our institution. METHOD The data was obtained from files documented and faxed by physicians from October 2009 to May 2012. One thousand nine hundred and seventy-two files were included. The file was faxed to the IDD specialist, analyzed, then a telephone conversation allowed making precisions, and the documented form was faxed back. RESULTS The requests for advice concerned 39% of female and 61% of male patients with a mean age of 64±21 years. Twenty-nine percent of requests came from surgical departments and 71% from medical departments (P<0.01). The departments most frequently concerned were cardiology (10%), gastro-enterology (10%) and cardiovascular surgery (9.7%). The most frequent infections were urogenital (19%), osteoarticular (14%), and cardiovascular (11%). Forty-nine percent were considered as nosocomial and 25.3% were bacteremic. The requests concerned diagnostic aid in 16.2% of cases and therapeutic issues in 95.6%. The IDD specialist made therapeutic recommendation in 96.5% of cases and gave diagnostic advice in 43.7%. Treatment modification was suggested in 38.5% of cases. Twenty-two percent of consultations required a second one. CONCLUSION This study documented the importance of antibiotic changes among medical and surgical units, the increasing need of these units to be helped, and also the complexity of the medical cases, all requiring the advice of an ID specialist. Our fax-phone-fax procedure seems to prevent the bias associated with informal consultations by phone, which is the most commonly used in other institutions.
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Vehreschild JJ, Morgen G, Cornely OA, Hartmann P, Koch S, Kalka-Moll W, Wyen C, Vehreschild MJGT, Lehmann C, Gillor D, Seifert H, Kremer G, Fätkenheuer G, Jung N. Evaluation of an infectious disease consultation programme in a German tertiary care hospital. Infection 2013; 41:1121-8. [PMID: 23925637 DOI: 10.1007/s15010-013-0512-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 07/16/2013] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate a newly implemented infectious disease (ID) consultation service in terms of patient care, outcome and antibiotic prescription and to describe factors influencing adherence to recommendations. METHODS Data from consultations during the first 6 months of the ID consultation program were collected and evaluated. Consultation requests, diagnostic results, treatment outcomes and antibiotic recommendations were categorised. Diagnostic and therapeutic recommendations were assessed and rated for adherence and outcome. Statistical analysis was performed to identify factors influencing adherence and treatment outcome. RESULTS A total of 251 consultations were assessed. In most cases, ID specialists were asked for further advice regarding a previously initiated anti-infective treatment (N = 131, 52 %). In 54 of 195 (28 %) first consultations, the ID specialist proposed a differential diagnosis that differed from that of the working diagnoses submitted with the consultation request, and which was subsequently confirmed in 80 % of these cases. Diagnostic and therapeutic recommendations were made in 190 (76 %) and 240 (96 %) of the consultations, respectively. A change in the current treatment was recommended in 66 % of consultations; 37 % of recommendations were cost-saving and 26 % were cost-neutral. Compliance with diagnostic and therapeutic recommendations was rated as good by pre-specified criteria in 65 and 86 % of consultations, respectively. Treatment outcome was correlated with adherence to diagnostic recommendations (P = 0.012). Twenty-nine patients (16 %) died during the same hospital stay. CONCLUSION Infectious disease consultations may help to establish the correct diagnosis, resulting in the appropriate treatment being provided to a severely sick patient population. Treatment outcome was improved in cases of good diagnostic adherence to the recommendations of the ID specialist.
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Affiliation(s)
- J J Vehreschild
- Department I for Internal Medicine, University Hospital of Cologne, Bettenhaus Ebene 15, Raum 65, 50924, Cologne, Germany,
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Cisneros JM, Palomino-Nicás J, Pachón-Diaz J. [The referral of infectious diseases is a key activity for infectious diseases departments and units, as well as for the hospital]. Enferm Infecc Microbiol Clin 2013; 32:671-5. [PMID: 23726832 DOI: 10.1016/j.eimc.2013.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 03/09/2013] [Accepted: 03/28/2013] [Indexed: 10/26/2022]
Abstract
Infectious diseases referrals (IDR) is a core activity of infectious diseases departments, and is certainly the one with the greatest potential impact on the hospital due to their cross-sectional nature, and with the emergence of a bacterial resistance and antimicrobial crisis. However, there is no standard model for IDR, no official training, and evaluation is merely descriptive. Paradoxically IDR are at risk in a health system that demands more quality and efficiency. The aim of this review is to assess what is known about IDR, its definition, key features, objectives, method, and the evaluation of results, and to suggest improvements to this key activity for the infectious diseases departments and the hospital.
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Affiliation(s)
- José Miguel Cisneros
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, Sevilla, España.
| | - Julián Palomino-Nicás
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, Sevilla, España
| | - Jerónimo Pachón-Diaz
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, Sevilla, España
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Lesprit P, Landelle C, Brun-Buisson C. Unsolicited post-prescription antibiotic review in surgical and medical wards: factors associated with counselling and physicians’ compliance. Eur J Clin Microbiol Infect Dis 2012; 32:227-35. [DOI: 10.1007/s10096-012-1734-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 08/14/2012] [Indexed: 11/30/2022]
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Pavese P, Sellier E, Laborde L, Gennai S, Stahl JP, François P. Requesting physicians' experiences regarding infectious disease consultations. BMC Infect Dis 2011; 11:62. [PMID: 21401916 PMCID: PMC3061908 DOI: 10.1186/1471-2334-11-62] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 03/14/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Solicited consultations constitute a substantial workload for infectious disease (ID) specialists in the hospital setting. The objectives of this survey were to describe requesting physicians' experiences regarding ID consultations. METHODS A cross-sectional survey was conducted in a university-affiliated hospital in France in 2009. All physicians were eligible (n = 530) and received a self-administered questionnaire. The main outcomes were reasons for request and opinion. Secondary outcomes were frequency of request and declared adherence to recommendations. RESULTS The participation rate was 44.7% (237/530). Among the responders, 187 (79%) had solicited the ID consultation service within the previous year. Ninety-three percent of the responders (173/187) were satisfied with the ID consultation. The main reasons for requesting consultations were the need for therapeutic advice (93%), quality of care improvement (73%) and the rapidity of access (61%). ID consultations were requested several times a month by 52% (72/138) of senior physicians and by 73% (36/49) of residents (p = 0.01). Self-reported adherence to diagnostic and therapeutic recommendations was 83% and 79%, respectively. CONCLUSION The respondent requesting physicians expressed great satisfaction regarding ID consultations that they requested principally to improve patient care and to assist in medical decision making.
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Affiliation(s)
- Patricia Pavese
- Infectious Diseases Unit, Grenoble University Hospital, F-38043, Grenoble, France
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Prospective study of telephone calls to a hotline for infectious disease consultation: analysis of 7,863 solicited consultations over a 1-year period. Eur J Clin Microbiol Infect Dis 2010; 30:509-14. [DOI: 10.1007/s10096-010-1111-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Accepted: 10/25/2010] [Indexed: 10/18/2022]
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Behar P, Wagner M, Petersen L, Boas MV. Is antibiotic prescribing on Saturdays higher than any other day of the week? J Hosp Infect 2010; 76:84-5. [DOI: 10.1016/j.jhin.2010.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 04/21/2010] [Indexed: 10/19/2022]
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Roger PM, Brofferio P, Labate C, Barrière JR, Minguet JM, Foulon P, Zumbo C. Évaluation prospective des associations antibiotiques d’un centre hospitalier général. Med Mal Infect 2010; 40:165-71. [DOI: 10.1016/j.medmal.2009.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Accepted: 08/31/2009] [Indexed: 10/20/2022]
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Sellier E, Pavese P, Gennai S, Stahl JP, Labarere J, Francois P. Factors and outcomes associated with physicians' adherence to recommendations of infectious disease consultations for inpatients. J Antimicrob Chemother 2009; 65:156-62. [DOI: 10.1093/jac/dkp406] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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[Evaluation of a remote infectious disease consultation]. Med Mal Infect 2009; 39:798-805. [PMID: 19796888 DOI: 10.1016/j.medmal.2009.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 06/23/2009] [Accepted: 08/31/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The aims of our study were to characterize the activity of a remote infectious diseases consultation (RIDC) in a teaching hospital and to assess physician observance to advice. DESIGN All demands received by the RIDC for initial advice and the given answers were recorded during one month. Advice given for inpatients was followed up 72 hours after to evaluate the physician's observance. RESULTS Six hundred and nineteen demands were recorded: 47% came from our teaching hospital and 53% came from community practice. Hospital demands came mostly from surgical (47%) and medical (41%) units. Most of them (92%) were related to the treatment of an infection or diagnostic help. Outside calls came from doctors (85%) either private or working in a health care institution. Prophylaxis (47%) and treatment of an infection or a diagnostic help (43%) were the most frequent issues. Among the 176 pieces of advice requested for inpatients, 87% were completely observed. Advice was more followed when it was given by experienced specialists (p=0.02) or by phone (p=0.03) and less followed for patients presenting a nosocomial infection (p=0.03). CONCLUSIONS The RIDC is very useful for the medical community and its advice is usually followed. Informal consultations account for an important part of its activity.
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Uçkay I, Vernaz-Hegi N, Harbarth S, Stern R, Legout L, Vauthey L, Ferry T, Lübbeke A, Assal M, Lew D, Hoffmeyer P, Bernard L. Activity and impact on antibiotic use and costs of a dedicated infectious diseases consultant on a septic orthopaedic unit. J Infect 2009; 58:205-12. [PMID: 19232739 DOI: 10.1016/j.jinf.2009.01.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Revised: 01/05/2009] [Accepted: 01/25/2009] [Indexed: 10/21/2022]
Abstract
UNLABELLED The Orthopaedic Service of the Geneva University Hospitals engages dedicated infectious disease (ID) specialists to assist in the treatment of infected patients. We investigated the daily clinical activity and the impact on antibiotic costs in the Septic Unit since 2000. METHODS Retrospective analysis of various databases. Prospective survey of clinical activity from January 2008 to March 2008. RESULTS According to the survey, the ID specialist performed 265 first-time and 1420 follow-up consultations (average of 11.4 consultations per working day). In 88% of cases the antibiotic regimen initiated by the surgeons was approved. When the ID specialist had to change antibiotic treatment, it was for de-escalation in 43.7%, discontinuance in 32.4%, and initiation in 24.4% of cases. From April 2007 to March 2008, the ID specialist decreased total antibiotic use by 43 DDD/100 patients-days (p=0.0006) in the Septic Unit. Direct antibiotic costs decreased by US$64,380 over the same period, equal to the annual salary of the ID specialist. There was no change in the number of recurrent infections. CONCLUSIONS The main antibiotic-related activity of the dedicated orthopaedic ID specialist in Geneva our institution was to discontinue or adjust a pre-existing antimicrobial therapy. This activity significantly reduced antibiotic use and related costs on a septic orthopaedic unit.
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Affiliation(s)
- Ilker Uçkay
- Orthopaedic Surgery Service, Geneva, Switzerland.
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Prendergast A, Walls T, Turner P, Cubitt D, Hartley J, Klein N, Novelli V. Comment on: Antimicrobial policies in the neonatal units of the United Kingdom and Republic of Ireland. J Antimicrob Chemother 2008; 62:429-30. [DOI: 10.1093/jac/dkn170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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