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Diggs DT, Tribble AC, Same RG, Newland JG, Lee BR. Appropriateness of antibiotic prescribing varies by clinical services at United States children's hospitals. Infect Control Hosp Epidemiol 2023; 44:1711-1717. [PMID: 37905378 PMCID: PMC10665883 DOI: 10.1017/ice.2023.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE To describe patterns of inappropriate antibiotic prescribing at US children's hospitals and how these patterns vary by clinical service. DESIGN Serial, cross-sectional study using quarterly surveys. SETTING Surveys were completed in quarter 1 2019-quarter 3 2020 across 28 children's hospitals in the United States. PARTICIPANTS Patients at children's hospitals with ≥1 antibiotic order at 8:00 a.m. on institution-selected quarterly survey days. METHODS Antimicrobial stewardship physicians and pharmacists collected data on antibiotic orders and evaluated appropriateness of prescribing. The primary outcome was percentage of inappropriate antibiotics, stratified by clinical service and antibiotic class. Secondary outcomes included reasons for inappropriate use and association of infectious diseases (ID) consultation with appropriateness. RESULTS Of 13,344 orders, 1,847 (13.8%) were inappropriate; 17.5% of patients receiving antibiotics had ≥1 inappropriate order. Pediatric intensive care units (PICU) and hospitalists contributed the most inappropriate orders (n = 384 and n = 314, respectively). Surgical subspecialists had the highest percentage of inappropriate orders (22.5%), and 56.8% of these were for prolonged or unnecessary surgical prophylaxis. ID consultation in the previous 7 days was associated with fewer inappropriate orders (15% vs 10%; P < .001); this association was most pronounced for hospitalist, PICU, and surgical and medical subspecialty services. CONCLUSIONS Inappropriate antibiotic use for hospitalized children persists and varies by clinical service. Across 28 children's hospitals, PICUs and hospitalists contributed the most inappropriate antibiotic orders, and surgical subspecialists' orders were most often judged inappropriate. Understanding service-specific prescribing patterns will enable antimicrobial stewardship programs to better design interventions to optimize antibiotic use.
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Affiliation(s)
- Devin T. Diggs
- College of Science, University of Notre Dame, Notre Dame, Indiana
| | - Alison C. Tribble
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Rebecca G. Same
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason G. Newland
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
| | - Brian R. Lee
- Division of Health Services and Outcomes Research, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri
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Lieng MK, Aurora MS, Kang Y, Kim JM, Marcin JP, Chan SR, Mouzoon JL, Tancredi DJ, Parish M, Gonzalez AD, Scher L, Xiong G, McCarron RM, Yellowlees P. Primary Care Physician Adherence to Telepsychiatry Recommendations: Intermediate Outcomes from a Randomized Clinical Trial. Telemed J E Health 2021; 28:838-846. [PMID: 34726542 DOI: 10.1089/tmj.2021.0389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To compare clinical recommendations given by psychiatrists and the adherence to these recommendations by primary care physicians (PCP) following consultations conducted by asynchronous telepsychiatry (ATP) and synchronous telepsychiatry (STP). Materials and Methods: ATP and STP consultations were compared using intermediate data from a randomized clinical trial with adult participant enrollment between April 2014 and December 2017. In both study arms, PCPs received written recommendations from the psychiatrist after each encounter. Independent clinicians reviewed PCP documentation to measure adherence to those recommendations in the 6 months following the baseline consultation. Results: Medical records were reviewed for 645 psychiatrists' consult recommendations; 344 from 61 ATP consultations and 301 from 62 STP consultations. Of those recommendations, 191 (56%) and 173 (58%) were rated fully adherent by two independent raters for ATP and STP, respectively. In a multilevel ordinal logistic regression model adjusted for recommendation type and recommended implementation timing, there was no statistically significant difference in adherence to recommendations for ATP compared with STP (adjusted odds ratio = 0.91, 95% confidence interval = 0.51-1.62). The profiles of recommendation type were comparable between ATP and STP. Conclusions: This is the first PCP adherence study comparing two forms of telemedicine. Although we did not find evidence of a difference between ATP and STP; this study supports the feasibility and acceptability of ATP and STP for the provision of collaborative psychiatric care. Clinical Trial Identifier NCT02084979.
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Affiliation(s)
- Monica K Lieng
- Department of Pediatrics, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA.,School of Medicine, University of California Davis Health, Sacramento, California, USA
| | - Magi S Aurora
- Department of Psychiatry, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA.,Department of Family Medicine, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA
| | - Young Kang
- School of Medicine, University of California Davis Health, Sacramento, California, USA.,Department of Internal Medicine, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA
| | - Joseph M Kim
- Department of Psychiatry, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA.,Department of Internal Medicine, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA
| | - James P Marcin
- Department of Pediatrics, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA
| | - Steven R Chan
- Department of Psychiatry, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA.,Veterans Health Administration, Palo Alto Health Care System, Palo Alto, California, USA
| | - Jamie L Mouzoon
- Department of Pediatrics, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA
| | - Daniel J Tancredi
- Department of Pediatrics, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA
| | - Michelle Parish
- Department of Psychiatry, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA
| | - Alvaro D Gonzalez
- Department of Psychiatry, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA
| | - Lorin Scher
- Department of Psychiatry, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA
| | - Glen Xiong
- Department of Psychiatry, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA
| | - Robert M McCarron
- School of Medicine, University of California Irvine, Irvine, California, USA
| | - Peter Yellowlees
- Department of Psychiatry, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA
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3
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Dos Santos RP, Dalmora CH, Lukasewicz SA, Carvalho O, Deutschendorf C, Lima R, Leitzke T, Correa NC, Gambetta MV. Antimicrobial stewardship through telemedicine and its impact on multi-drug resistance. J Telemed Telecare 2018; 25:294-300. [PMID: 29720043 DOI: 10.1177/1357633x18767702] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Telemedicine technologies are increasingly being incorporated into infectious disease practice. We aimed to demonstrate the impact of antimicrobial stewardship through telemedicine on bacterial resistance rates. METHODS We conducted a quasi-experimental study in a 220-bed hospital in southern Brazil. An antimicrobial stewardship program incorporating the use of telemedicine was implemented. Resistance and antimicrobial consumption rates were determined and analysed using a segmented regression model. RESULTS After the intervention, the rate of appropriate antimicrobial prescription increased from 51.4% at baseline to 81.4%. Significant reductions in the consumption of fluoroquinolones (level change, β = -0.80; P < 0.01; trend change, β = -0.01; P = 0.98), first-generation cephalosporins (level change, β = -0.91; P < 0.01; trend change, β = +0.01; P = 0.96), vancomycin (level change, β = -0.47; P = 0.04; trend change, β = +0.17; P = 0.66) and polymyxins (level change, β = -0.15; P = 0.56; trend change, β = -1.75; P < 0.01) were identified. There was an increase in the consumption of amoxicillin + clavulanate (level change, β = +0.84; P < 0.01; trend change, β = +0.14; P = 0.41) and cefuroxime (level change, β = +0.21; P = 0.17; trend change, β = +0.66; P = 0.02). A significant decrease in the rate of carbapenem-resistant Acinetobacter spp. isolation (level change, β = +0.66; P = 0.01; trend change, β = -1.26; P < 0.01) was observed. CONCLUSIONS Telemedicine, which provides a tool for decision support and immediate access to experienced specialists, can promote better antibiotic selection and reductions in bacterial resistance.
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Affiliation(s)
- Rodrigo P Dos Santos
- 1 Hospital Infection Control Committee, Hospital de Clínicas de Porto Alegre, Brazil.,2 Hospital Infection Control Committee, 37895 Instituto de Cardiologia de Porto Alegre , Brazil.,3 Qualis, Porto Alegre, Brazil
| | - Camila H Dalmora
- 2 Hospital Infection Control Committee, 37895 Instituto de Cardiologia de Porto Alegre , Brazil.,3 Qualis, Porto Alegre, Brazil
| | | | - Otávio Carvalho
- 1 Hospital Infection Control Committee, Hospital de Clínicas de Porto Alegre, Brazil.,3 Qualis, Porto Alegre, Brazil
| | - Caroline Deutschendorf
- 2 Hospital Infection Control Committee, 37895 Instituto de Cardiologia de Porto Alegre , Brazil.,3 Qualis, Porto Alegre, Brazil
| | | | - Tiago Leitzke
- 4 Hospital Infection Control Committee, Hospital Regional do Alto Vale, Brazil
| | - Nilson C Correa
- 4 Hospital Infection Control Committee, Hospital Regional do Alto Vale, Brazil
| | - Marcelo V Gambetta
- 4 Hospital Infection Control Committee, Hospital Regional do Alto Vale, Brazil
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Esposito S, Russo E, De Simone G, Gioia R, Petta E, Leone S, Noviello S, Artioli S, Ascione T, Bartoloni A, Bassetti M, Bertelli D, Boccia G, Borrè S, Brugnaro P, Caramello P, Coen M, Crisalli MP, De Caro F, Dodi F, Fantoni M, Foti G, Giacometti A, Leoncini F, Libanore M, Migliore S, Venditti M. Diagnostic and therapeutic appropriateness in bone and joint infections: results of a national survey. J Chemother 2017; 28:191-7. [PMID: 25800800 DOI: 10.1179/1973947815y.0000000012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The impact of infectious diseases (ID) specialist consultation in the management of many types of bacterial infections has been fully demonstrated but not for bone and joint infections (BJIs). Nineteen ID Italian centres collected of data from June 2009 to May 2012. Italian guidelines (2009) were used to determine the appropriateness of the diagnostic and therapeutic process of BJIs before and after consulting an ID specialist. Data on 311 patients were collected: 111 cases of prosthetic joint infection, 99 osteomyelitis, 64 spondylodiscitis and 37 fixation device infection. A significant increase of microbiological investigations, imaging techniques and blood inflammation markers were noted after consulting the ID specialist. Moreover, inappropriateness of treatment duration, dosage, and number of administrations significantly decreased after consultation. Infectious disease specialist intervention in the management of BJIs significantly increases the appropriateness both in performing instrumental and laboratory analysis, but especially in determining the correct therapy.
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Affiliation(s)
- Silvano Esposito
- a Infectious Diseases Unit , University of Salerno, San Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno , Italy
| | - Enrico Russo
- a Infectious Diseases Unit , University of Salerno, San Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno , Italy
| | - Giuseppe De Simone
- a Infectious Diseases Unit , University of Salerno, San Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno , Italy
| | - Renato Gioia
- a Infectious Diseases Unit , University of Salerno, San Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno , Italy
| | - Ester Petta
- a Infectious Diseases Unit , University of Salerno, San Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno , Italy
| | - Sebastiano Leone
- a Infectious Diseases Unit , University of Salerno, San Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno , Italy
| | - Silvana Noviello
- a Infectious Diseases Unit , University of Salerno, San Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno , Italy
| | - Stefania Artioli
- b Infectious Diseases Unit , Levante Ligure Hospital, Levante Ligure , Italy
| | - Tiziana Ascione
- c Infectious Diseases Unit , Cotugno Hospital, Naples , Italy
| | - Alessandro Bartoloni
- d Infectious Diseases Unit , University of Florence, Careggi Hospital, Florence , Italy
| | - Matteo Bassetti
- e Infectious Diseases Unit , AOU Santa Maria della Misericordia, Udine , Italy
| | - Davide Bertelli
- f Infectious Diseases Unit , A. O. Spedali Civili, Brescia , Italy
| | - Giovanni Boccia
- g Hygiene Unit , University of Salerno, San Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno , Italy
| | - Silvio Borrè
- h Infectious Diseases Unit , S. Andrea Hospital, Vercelli , Italy
| | - Pierluigi Brugnaro
- i Infectious Diseases Unit , "SS. Giovanni e Paolo" Hospital, Castello, Venice , Italy
| | - Pietro Caramello
- j Infectious Diseases Unit , Amedeo di Savoia Hospital, Turin , Italy
| | - Massimo Coen
- k Infectious Diseases Unit , Sacco Hospital, Milan , Italy
| | | | - Francesco De Caro
- g Hygiene Unit , University of Salerno, San Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno , Italy
| | - Ferdinando Dodi
- m Infectious Diseases Unit , IRCCS San Martino, Genoa , Italy
| | - Massimo Fantoni
- n Infectious Diseases Institute, Catholic S. Cuore, Gemelli Hospital , Rome , Italy
| | - Giuseppe Foti
- o Infectious Diseases Unit , Bianchi Melacrino Morelli Hospital, Reggio Calabria , Italy
| | | | | | - Marco Libanore
- r Infectious Diseases Unit , University of Ferrara, Ferrara , Italy
| | - Simona Migliore
- s Infectious Diseases Unit , Ragusa Hospital, Ragusa , Italy
| | - Mario Venditti
- t Infectious Diseases Institute, University of Rome La Sapienza , Rome , Italy
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Sasikumar M, Boyer S, Remacle-Bonnet A, Ventelou B, Brouqui P. The value of specialist care-infectious disease specialist referrals-why and for whom? A retrospective cohort study in a French tertiary hospital. Eur J Clin Microbiol Infect Dis 2016; 36:625-633. [PMID: 27858243 DOI: 10.1007/s10096-016-2838-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/31/2016] [Indexed: 11/25/2022]
Abstract
This study evaluated the impact of infectious disease (ID) specialist referrals on outcomes in a tertiary hospital in France. This study tackled methodological constraints (selection bias, endogeneity) using instrumental variables (IV) methods in order to obtain a quasi-experimental design. In addition, we investigated whether certain characteristics of patients have a bearing on the impact of the intervention. We used the payments database and ID department files to obtain data for adults admitted with an ID diagnosis in the North Hospital, Marseille from 2012 to 2014. Comparable cohorts were obtained using coarsened exact matching and analysed using IV models. Mortality, readmissions, cost (payer perspective) and length of stay (LoS) were analysed. We recorded 15,393 (85.97%) stays, of which 2,159 (14.03%) benefited from IDP consultations. The intervention was seen to significantly lower the risk of inpatient mortality (marginal effect (M.E) = -19.06%) and cost of stay (average treatment effect (ATE) = - €5,573.39). The intervention group was seen to have a longer LoS (ATE = +4.95 days). The intervention conferred a higher reduction in mortality and cost for stays that experienced ICU care (mortality: odds ratio (OR) =0.09, M.E cost = -8,328.84 €) or had a higher severity of illness (mortality: OR=0.35, M.E cost = -1,331.92 €) and for patients aged between 50 and 65 years (mortality: OR=0.28, M.E cost = -874.78 €). This study shows that ID referrals are associated with lower risk of inpatient mortality and cost of stay, especially when targeted to certain subgroups.
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Affiliation(s)
- M Sasikumar
- SESSTIM, UMR 912 INSERM, Aix-Marseille University (Aix-Marseille School of Economics), Marseille, France.
| | - S Boyer
- SESSTIM, UMR 912 INSERM-IRD, Aix-Marseille Université, Marseille, France
| | - A Remacle-Bonnet
- Service d'Information Médicale, APHM CHU Nord Marseille, Marseille, France
| | - B Ventelou
- CNRS & EHESS, Aix-Marseille University (Aix-Marseille School of Economics), Marseille, France
| | - P Brouqui
- IHU Méditerranée Infection; URMITE; UM63; CNRS 7278; IRD 198; Inserm 1095, Aix Marseille Université, Marseille, France
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Rieg S, Küpper MF. Infectious diseases consultations can make the difference: a brief review and a plea for more infectious diseases specialists in Germany. Infection 2016; 44:159-66. [PMID: 26908131 DOI: 10.1007/s15010-016-0883-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/08/2016] [Indexed: 01/15/2023]
Abstract
Trained infectious diseases (ID) specialists are an integral part of inpatient and outpatient care in many countries, however, these specialized services are established only in selected tertiary care hospitals in Germany. This review summarises studies that addressed the impact of ID consultation services on patient care and outcome. Extensive data for a clinical benefit is available in the context of Staphylococcus aureus bacteremia (SAB), in which in-hospital or 30-day mortality was significantly reduced by 40-50 % in patients evaluated and treated in cooperation with ID consultants. This effect was associated with improved adherence to quality-of-care standards. Moreover, newer studies show a reduced length of hospital stay due to ID consultations, especially if patients are evaluated early in the course of their hospital stay. Of note, informal consultations do not seem to be equivalent to a formal ID consultation with bedside patient evaluation. Studies in other patient groups (solid organ transplant recipients or intensive care unit patients) or in the context of other infections (infective endocarditis, pneumonia, other bloodstream infections) also revealed positive effects of ID consultations. Higher rates of appropriate empirical and targeted antimicrobial treatments and de-escalation strategies due to successful pathogen identification were documented. These modifications resulted in lower treatment costs and decreased antimicrobial resistance development. Although there are methodological limitations in single studies, we consider the consistent and reproducible positive effects of ID consultations shown in studies in different countries and health care systems as convincing evidence for improved quality-of-care and treatment outcomes in patients with infectious diseases. Thus, we strongly recommend efforts to establish significantly more ID consultation services in hospitals in Germany.
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Affiliation(s)
- Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, University Medical Center, Albert-Ludwigs-University Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Marc Fabian Küpper
- Division of Infectious Diseases, Department of Medicine II, University Medical Center, Albert-Ludwigs-University Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
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7
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[Impact of an infectious diseases consultation service on the quality of care and the survival of patients with infectious diseases]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2015; 109:500-10. [PMID: 26593765 DOI: 10.1016/j.zefq.2015.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/03/2015] [Accepted: 09/03/2015] [Indexed: 11/20/2022]
Abstract
While trained infectious diseases (ID) specialists are regularly involved in inpatient and outpatient care in the United States and Canada, these specialized services are only rarely established in Germany. This article aims to summarize the findings of numerous studies that investigated the impact of ID consultation services on patient care and outcome in patients suffering from infectious diseases. The strongest evidence for a clinical benefit is found in the context of Staphylococcus aureus bacteremia (SAB), where in-hospital- and day-30 mortality was significantly and consistently reduced by about 40% in patients that were evaluated and treated in cooperation with an ID physician. Furthermore, studies revealed that this effect was associated with an improved adherence to standards of care. Newer studies show a reduced length of hospital stay due to ID consultations, especially if patients are evaluated early in the course of their hospital stay. Of note, informal or curbside consultations do not seem to be equivalent to a formal ID consultation with bedside patient evaluation. Studies in other patient groups (solid organ transplant recipients or intensive care unit patients) or in the context of other infections (infective endocarditis, pneumonia, other bloodstream infections) also revealed positive effects of ID consultations. Higher rates of appropriate empirical and targeted antimicrobial treatments and de-escalation strategies due to successful pathogen identification were documented. These modifications resulted in lower treatment costs and decreased antimicrobial resistance development. Although there are methodological limitations in single studies, we consider the consistent and reproducible positive effects of ID consultations shown in studies in different countries and health care systems as convincing evidence for the improved quality of care and treatment outcomes in patients with infectious diseases. Thus, strong consideration should be given to establish ID consultation services in small and medium sized hospitals as well.
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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: 1.5] [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: 7.6] [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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10
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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: 0.6] [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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Marquet A, Ollivier F, Boutoille D, Thibaut S, Potel G, Ballereau F. A national network of infectious diseases experts. Med Mal Infect 2013; 43:475-80. [PMID: 24262913 DOI: 10.1016/j.medmal.2013.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 07/24/2013] [Accepted: 09/25/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of this study was to consider the implementation of a network of infectious diseases (ID) experts to optimize the antibiotic prescriptions of community and hospital practitioners. METHODS An observational prospective study was conducted among ID experts in the Pays-de-la-Loire Region to evaluate the number of calls and to determine the practitioner's reasons for soliciting ID expertise. For each phone consultation, four criteria were recorded during 5 days: origin of the call (internal/external), kind of question (diagnostic/therapeutic) time spent for the advice provided, type of advice. RESULTS A total of 386 phone consultations for 20 infectious disease specialists were recorded during the study period (5 days); 81% were internal to the hospital, 7.7% from another hospital, and 11.3% from private practice, 56.3% of the questions concerned a therapeutic strategy, 21% a diagnostic advice, and 22.6% concerned both diagnosis and therapy. Two third of the questions were answered within 10minutes. In 68.7% of cases, the ID specialist answered immediately, 19.8% of calls required following-up the patient, 6% led to refer the patient to an ID consultation, and 5.5% to hospitalization. CONCLUSION The survey results stress the important need for such ID expertise, both in hospitals and in ambulatory medicine. Collaboration of ID specialists in a regional network would allow an easy and permanent access to antibiotic therapy advice for prescribers. This network would improve the quality and safety of care.
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Affiliation(s)
- A Marquet
- Centre MedQual, hôpital St-Jacques, CHU de Nantes, 85, rue St-Jacques, 44093 Nantes, France.
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12
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Bouza E. Editorial Commentary: Infectious Diseases: A Friend in Need. Clin Infect Dis 2013; 58:29-31. [DOI: 10.1093/cid/cit620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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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: 1.4] [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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Santos RPD, Deutschendor C, Carvalho OF, Timm R, Sparenberg A. Antimicrobial Stewardship Through Telemedicine in a Community Hospital in Southern Brazil. J Telemed Telecare 2013; 19:1-4. [DOI: 10.1177/1357633x12473901] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We developed an antimicrobial stewardship programme, based on telemedicine, for a remote community hospital in southern Brazil. Expertise in infectious diseases was provided from a 250-bed tertiary hospital for cardiology patients located 575 km away. At the community hospital, antimicrobial prescriptions were completed via a secure web site. A written reply was sent back to the prescriber by email and SMS text message. During a 4-month study period there were 81 prescriptions for 76 patients. Most antimicrobial prescriptions (67%) were for respiratory infections. Ampicillin was prescribed in 44% of cases ( n = 56), gentamicin in 18% of cases ( n = 23) and azithromycin in 18% of cases ( n = 23). Two infectious diseases specialists independently reviewed each antimicrobial prescription. A total of 41 prescriptions (55%) were considered inappropriate. The median time to obtain a second opinion via the web site was 22 min (interquartile range 12–55). Overall compliance with the recommendations of the infectious diseases specialist was 100% (81 out of 81 requests). Telemedicine appears to have a useful potential role in antimicrobial stewardship programmes.
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Affiliation(s)
- Rodrigo Pires Dos Santos
- Infection Control Committee, Instituto de Cardiologia do Rio Grande do Sul. Porto Alegre, Brazil
- Infection Control Committee, Hospital de Clínicas de Porto Alegre. Porto Alegre, Brazil
| | - Caroline Deutschendor
- Infection Control Committee, Hospital de Clínicas de Porto Alegre. Porto Alegre, Brazil
| | - Otavio Fontoura Carvalho
- Infection Control Committee, Instituto de Cardiologia do Rio Grande do Sul. Porto Alegre, Brazil
| | - Robert Timm
- E-health Centre, Instituto de Cardiologia do Rio Grande do Sul. Porto Alegre, Brazil
| | - Adolfo Sparenberg
- E-health Centre, Instituto de Cardiologia do Rio Grande do Sul. Porto Alegre, Brazil
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Mondain V, Lieutier F, Dumas S, Gaudart A, Fosse T, Roger PM, Bernard E, Farhad R, Pulcini C. An antibiotic stewardship program in a French teaching hospital. Med Mal Infect 2013; 43:17-21. [DOI: 10.1016/j.medmal.2012.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 09/24/2012] [Accepted: 10/31/2012] [Indexed: 12/01/2022]
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Fariñas MC, Saravia G, Calvo-Montes J, Benito N, Martínez-Garde JJ, Fariñas-Alvarez C, Aguilar L, Agüero R, Amado JA, Martínez-Martínez L, Gómez-Fleitas M. Adherence to recommendations by infectious disease consultants and its influence on outcomes of intravenous antibiotic-treated hospitalized patients. BMC Infect Dis 2012; 12:292. [PMID: 23140210 PMCID: PMC3514236 DOI: 10.1186/1471-2334-12-292] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 11/07/2012] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Consultation to infectious diseases specialists (ID), although not always performed by treating physicians, is part of hospital's daily practice. This study analyses adherence by treating physicians to written ID recommendations (inserted in clinical records) and its effect on outcome in hospitalized antibiotic-treated patients in a tertiary hospital in Spain. METHODS A prospective, randomized, one-year study was performed. Patients receiving intravenous antimicrobial therapy prescribed by treating physicians for 3 days were identified and randomised to intervention (insertion of written ID recommendations in clinical records) or non-intervention. Appropriateness of empirical treatments (by treating physicians) was classified as adequate, inadequate or unnecessary. In the intervention group, adherence to recommendations was classified as complete, partial or non-adherence. RESULTS A total of 1173 patients were included, 602 in the non-intervention and 571 in the intervention group [199 (34.9%) showing complete adherence, 141 (24.7%) partial adherence and 231 (40.5%) non-adherence to recommendations]. In the multivariate analysis for adherence (R2 Cox=0.065, p=0.009), non-adherence was associated with prolonged antibiotic prophylaxis (p=0.004; OR=0.37, 95%CI=0.19-0.72). In the multivariate analysis for clinical failure (R2 Cox=0.126, p<0.001), Charlson index (p<0.001; OR=1.19, 95%CI=1.10-1.28), malnutrition (p=0.006; OR=2.00, 95%CI=1.22-3.26), nosocomial infection (p<0.001; OR=4.12, 95%CI=2.27-7.48) and length of hospitalization (p<0.001; OR=1.01, 95%CI=1.01-1.02) were positively associated with failure, while complete adherence (p=0.001; OR=0.35, 95%CI=0.19-0.64) and adequate initial treatment (p=0.010; OR=0.39, 95%CI=0.19-0.80) were negatively associated. CONCLUSIONS Adherence to ID recommendations by treating physicians was associated with favorable outcome, in turn associated with shortened length of hospitalization. This may have important health-economic benefits and stimulates further investigation. TRIAL REGISTRATION Current Controlled Trials ISRCTN83234896. http://www.controlled-trials.com/isrctn/sample_documentation.asp.
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Affiliation(s)
- María-Carmen Fariñas
- Infectious Diseases Unit, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008 Santander, Spain
| | - Gabriela Saravia
- Infectious Diseases Unit, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008 Santander, Spain
| | - Jorge Calvo-Montes
- Microbiology Department, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain
| | - Natividad Benito
- Infectious Diseases Unit, Hospital Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - Juan-José Martínez-Garde
- Pharmacy Department, Hospital Universitario Marques de Valdecilla, Av. Valdecilla s/n, 39008, Santander, Spain
| | - Concepción Fariñas-Alvarez
- Preventive Medicine Department, Hospital Sierrallana, Bª Ganzo s/n, 39300, Torrelavega, Cantabria, Spain
| | - Lorenzo Aguilar
- Microbiology Department, School of Medicine Universidad Complutense, Avda. Complutense s/n, 28040, Madrid, Spain
| | - Ramón Agüero
- Pneumology Department, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain
| | - José-Antonio Amado
- Endocrinology Department, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain
| | - Luis Martínez-Martínez
- Microbiology Department, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain
- Department of Molecular Biology, University of Cantabria, Avda. Cardenal Herrera Oria s/n, 39011, Santander, Spain
| | - Manuel Gómez-Fleitas
- General Surgery Department, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain
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Clinical benefit of infectious diseases consultation: a monocentric prospective cohort study. Infection 2012; 40:501-7. [PMID: 22723076 DOI: 10.1007/s15010-012-0283-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 05/30/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To determine the association of clinical outcomes with the adherence to Infectious Diseases Consultation (IDC) recommendations. METHODS From March to August 2009, all patients hospitalized in our hospital, for whom an IDC was requested, were prospectively enrolled. The adherence to recommendations was ascertained after 72 h from the IDC. The primary objective of the study was to evaluate the clinical cure rate 1 month after the IDC, according to the adherence to IDC recommendations. RESULTS An IDC was requested for 258 inpatients. The infectious disease (ID) was most often non-severe (66%), community-acquired (62%), and already under treatment (47%). IDC proposals were most often formulated via a formal consultation (57%). Physicians' adherence to IDC recommendations was 87% for diagnostic tests and 90% for antibiotherapy. In the multivariate analysis, severe infections and direct consultation were independently associated with increased odds of adherence to recommendations for performing diagnostic tests (odds ratios 5.4 and 4.0, respectively). The overall clinical cure rate was 84% and this did not differ according to the adherence to IDC recommendations for diagnostic tests (84.3 vs. 71.4%, p = 0.15) and antimicrobial treatment (84.8 vs. 77.8%, p = 0.34). CONCLUSIONS Some limitations of the study may explain the lack of evidence of a clinical benefit, such as the very high level of adherence to IDC recommendations and the low proportion of severe infections. However, clinical improvement was always better when recommendations were followed. Therefore, further larger randomized multicentric studies including more patients suffering from more severe IDs may be needed in order to demonstrate a clinical impact.
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Gilsdorf JR. Curbside Consultations in Pediatric Infectious Diseases. J Pediatric Infect Dis Soc 2012; 1:87-90. [PMID: 26618698 DOI: 10.1093/jpids/pis011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 01/18/2012] [Indexed: 11/12/2022]
Abstract
The Pediatric ID Consultant section provides brief reviews of topics relevant to the day-to-day practice of pediatric infectious diseases. The reviews are placed in context by a short vignette, followed by one or more questions which are addressed. Pediatric infectious diseases physicians are often asked by medical colleagues to provide recommendations for management of a patient without the benefit of a formal consultation. This article relates a story exemplifying such a request and discusses the possible quality of care, medical liability, and financial implications of informal consultations.
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Affiliation(s)
- Janet R Gilsdorf
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor
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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: 1.5] [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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