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Hadano Y, Matsumoto T. Non-infectious diseases in infectious disease consultation: A descriptive study in a tertiary care teaching hospital. PLoS One 2023; 18:e0295708. [PMID: 38064467 PMCID: PMC10707697 DOI: 10.1371/journal.pone.0295708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
In this retrospective study, we aimed to investigate the frequency, trend, and nature of non-infectious diseases (non-IDs) as the final diagnosis for patients during an infectious disease (ID) consultation in an acute care hospital in Japan. This study included adult inpatients who underwent ID consultations between October 2016 and March 2018. The demographic data, clinical manifestations, and final non-ID diagnoses of cases were explored. Among the 502 patients who underwent ID consultations, 45 (9.0%) were diagnosed with non-IDs. The most common diagnoses were tumors (22.2%, n = 10), connective tissue and collagen vascular diseases (13.3%, n = 6), other inflammatory diseases (8.9%, n = 4), and drug-induced fever (8.9%, n = 4). Multiple logistic regression analysis showed that the presence of consultations for diagnosis (odds ratio [OR], 22.0; 95% confidence interval [CI], 10.1-48.2; p<0.01), consultations from the internal medicine department (OR, 2.5; 95% CI, 1.2-5.2; p = 0.02), and non-bacteremia cases (OR, 5.2; 95% CI, 1.4-19.3; p = 0.01) were independently associated with diagnosed non-IDs. Non-IDs after ID consultations were mainly tumor-related, inflammatory diseases, and drug fever. The presence of consultations for diagnosis, consultations from the internal medicine department and non-bacteremia cases were related to non-IDs among ID consultations. Further research is needed to explore the frequency and pattern of non-IDs to improve the quality of ID consultations in daily practice.
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Affiliation(s)
- Yoshiro Hadano
- Division of Infection Control and Prevention, Shimane University Hospital, Izumo Shimane, Japan
- Department of Infectious Diseases, St. Mary’s Hospital, Kurume, Japan
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Takamatsu A, Honda H. Post-sign-off events in infectious disease consultation and the incidence of nonadherence to infectious disease recommendations in the post-sign-off period: A retrospective cohort study. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e38. [PMID: 36960090 PMCID: PMC10028937 DOI: 10.1017/ash.2023.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 03/05/2023]
Abstract
Objective Infectious diseases (ID) consultation has contributed to improving outcomes in hospitalized patients. However, the timing of signing off on ID consultation varies, depending on the consulting ID physician. We studied the descriptive epidemiology of treatment-related adverse events (ADEs) occurring after the ID physician has signed off on consultation and the epidemiology and predictors of nonadherence to ID recommendations in the post-sign-off period. Methods This retrospective cohort study was conducted at a Japanese tertiary-care center. All patients who received ID consultation between January and December 2019 and treatment recommendations for a confirmed or suspected infectious disease were included. The incidence of any treatment-related ADE after signing off, nonadherence to the final ID recommendations, and factors associated with nonadherence to the ID recommendations were identified. Results In total, 367 patients receiving ID consultation were included. The incidence of post-sign-off events during index hospitalization was 59 (16.1%) of 367, with antimicrobial-associated ADEs accounting for 26 events (44.1%) and HAIs accounting for 13 events (22.0%). After excluding patients who discontinued treatment, nonadherence to ID recommendations was identified in 55 (15.7%) of 351 patients. Newly acquired HAIs during the index hospitalization after signing off on ID consultation was an independent risk factor for nonadherence to ID recommendations (adjusted odds ratio, 3.78; 95% confidence interval, 1.14-12.52). Conclusions Post-sign-off events were common and led to nonadherence to ID recommendations during the post-sign-off period. Because this nonadherence occurs for various reasons, patients may require continued attention after signing off to ensure their safety.
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Affiliation(s)
- Akane Takamatsu
- Department of Microbiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
- Author for correspondence: Hitoshi Honda, MD, Department of Infectious Diseases, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi470-1192, Japan. E-mail: . Or Akane Takamatsu, MD, Department of Microbiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan. E-mail:
| | - Hitoshi Honda
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
- Department of Infectious Diseases, Fujita Health University School of Medicine, Aichi, Japan
- Author for correspondence: Hitoshi Honda, MD, Department of Infectious Diseases, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi470-1192, Japan. E-mail: . Or Akane Takamatsu, MD, Department of Microbiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan. E-mail:
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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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Richards L, Spencer DC, Nel JS, Ive P. Infectious disease consultations at a South African academic hospital: A 6-month assessment of inpatient consultations. S Afr J Infect Dis 2021; 35:169. [PMID: 34485477 PMCID: PMC8378114 DOI: 10.4102/sajid.v35i1.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 06/25/2020] [Indexed: 11/01/2022] Open
Abstract
Background Infectious diseases (IDs) dominate the disease profile in South Africa (SA) and the ID department is increasingly valuable. There has been little evaluation of the IDs consultation services in SA hospitals. Methods A qualitative review of ID inpatient consultations was performed over 6 months at a SA tertiary hospital. Prospectively entered data from each consultation were recorded on a computerised database and retrospectively analysed. Results 749 ID consultations were analysed, 4.8% of hospital admissions. Most consultations included initiation of antiretroviral therapy (ART) (27.8%), lipoarabinomannan antigen testing (24.8%) and change of ART (21.6%). Of patients reviewed, 93.3% were human immunodeficiency virus (HIV) positive and the median CD4 count was 52 cells/mm3. The infectious diagnoses (excluding HIV) most frequently encountered were pulmonary and abdominal tuberculosis (TB) and acute gastroenteritis. When all subcategories of TB infection were combined, 42.9% were found to have TB. Patients had predominantly one (45.4%) or two (30.2%) infectious diagnoses in addition to HIV. Some (12%) had three infectious diagnoses during their admission. The number of diagnoses, both infectious (odds ratio [OR] 2.00; 95% confidence interval [CI] 1.11-3.60) and non-infectious (OR 2.27; 95% CI 1.25-4.11), was associated with increased odds of death. Conclusion The IDs department sees a high volume of patients compared to most developed countries. HIV, TB and their management dominate the workload. This study shows that HIV patients still have significant morbidity and mortality. The complexity of these patients indicates that specific expertise is required beyond that of the general physician.
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Affiliation(s)
- Lauren Richards
- Division of Infectious Diseases, Department of Medicine, Faculty of Health Sciences, Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - David C Spencer
- Division of Infectious Diseases, Department of Medicine, Faculty of Health Sciences, Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa.,Clinical HIV Research Unit (CHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Jeremy S Nel
- Division of Infectious Diseases, Department of Medicine, Faculty of Health Sciences, Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Prudence Ive
- Division of Infectious Diseases, Department of Medicine, Faculty of Health Sciences, Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa
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Perozziello A, Lescure FX, Truel A, Routelous C, Vaillant L, Yazdanpanah Y, Lucet JC. Prescribers' experience and opinions on antimicrobial stewardship programmes in hospitals: a French nationwide survey. J Antimicrob Chemother 2020; 74:2451-2458. [PMID: 31167027 DOI: 10.1093/jac/dkz179] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 03/19/2019] [Accepted: 04/04/2019] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To assess prescribers' experiences and opinions regarding antimicrobial stewardship programme (ASP) activities. METHODS A cross-sectional paper-based survey was conducted among prescribers in 27 out of 35 randomly selected large hospitals in France. RESULTS All 27 investigated hospitals (20 non-university public, 4 university-affiliated and 3 private hospitals) had an ASP and an appointed antibiotic advisor (AA), with a median of 0.9 full-time equivalents per 1000 acute-care beds (IQR 0-1.4). Of the 1963 distributed questionnaires, 920 were completed (46.9%). Respondents were mainly attending physicians (658/918, 71.7%) and medical specialists (532/868, 61.3%). Prescribers identified two main ASP objectives: to limit the spread of resistance (710/913, 77.8%) and to improve patient care and prognosis (695/913, 76.1%). The presence of an AA constituted a core element of ASP (96.2% agreement between answers of ASP leader and respondents). Respondents acknowledged an AA's usefulness especially on therapeutic issues, i.e. choosing appropriate antibiotic (agreement 84.7%) or adapting treatment (89.6%), but less so on diagnostic issues (31.4%). Very few respondents reported unsolicited counselling and post-prescription controls. Three-quarters of prescribers identified local guidelines (692/918, 75.4%). Prescribers did not approve of measures counteracting their autonomy, i.e. automatic stop orders (agreement 23.4%) or pre-approval by AAs (28.8%). They agreed more with educational interventions (73.0%) and clinical staff meetings (70.0%). CONCLUSIONS Prescribers perceived ASP mainly through its 'on-demand' counselling activities. They preferred measures that did not challenge their clinical autonomy. High levels of antibiotic consumption in French hospitals bring into question the effectiveness of such an approach. However, limited ASP staffing and resources may preclude extended activities.
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Affiliation(s)
- A Perozziello
- IAME, UMR 1137, DeSCID team, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - F X Lescure
- IAME, UMR 1137, DeSCID team, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - A Truel
- IAME, UMR 1137, DeSCID team, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - C Routelous
- Institut du Management/EA 7348 MOS Management des organisations en santé, Ecole des hautes études en santé publique, EHESP, Rennes, Sorbonne Paris Cité, Paris, France
| | - L Vaillant
- UHLIN, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Y Yazdanpanah
- IAME, UMR 1137, DeSCID team, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - J C Lucet
- IAME, UMR 1137, DeSCID team, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,UHLIN, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
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Hadano Y, Watari T, Yasunaga H. Infectious disease consultations and newly diagnosed cancer patients: A single-center retrospective observational study. Medicine (Baltimore) 2020; 99:e20876. [PMID: 32569236 PMCID: PMC7310885 DOI: 10.1097/md.0000000000020876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Noninfectious diseases may be diagnosed during infectious disease (ID) consultations. Among non-IDs, cancer diagnosis is important; however, epidemiological data describing the relationship between ID consultations and newly diagnosed cancer patients are scarce. This study described the frequency and tendency of new cancer diagnoses in patients after ID consultation.This retrospective study included adult inpatients who underwent ID consultations between October 2016 and March 2018. The demographic data and clinical manifestations of each case are described.Among the 380 inpatients who underwent ID consultations, 6 (1.6%) received a new cancer diagnosis after ID consultation. Among the initial most likely diagnoses, 3 patients were diagnosed with IDs and 3 were diagnosed with non-IDs. The initial most likely ID diagnosis was important for new cancer diagnoses (P = .004, odds ratio: 11.1, 95% confidence interval: 2.11-57.2); diagnostic errors, as judged by the physicians, occurred in 2 of the 6 cases.While the frequency of establishing new diagnoses during ID consultations is low, coexisting infection and cancer is possible. ID specialists should identify any patterns related to new cancer diagnosis in patients to prevent diagnostic error and improve the quality of diagnosis.
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Affiliation(s)
- Yoshiro Hadano
- Department of Infectious Diseases, St. Mary's Hospital, Kurume
- Biostatistics Center, Kurume University School of Medicine, Kurume
| | - Takashi Watari
- Postgraduate Clinical Training Center, Shimane University Hospital, Izumo
| | - Hiroshi Yasunaga
- Department of Cardiovascular Surgery, St. Mary's Hospital, Kurume, Japan
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7
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Suren C, Feihl S, Querbach C, Rämer P, Pohlig F, Thurner J, Bernard R, Busch D, VON Eisenhart-Rothe R, Mühlhofer HML. Integrated IT Platform for Coordination of Diagnosis, Treatment, and Aftercare of Prosthetic Joint Infections. In Vivo 2019; 33:1625-1633. [PMID: 31471415 DOI: 10.21873/invivo.11647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/14/2019] [Accepted: 06/28/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND/AIM Prosthetic joint infections (PJI) are difficult to diagnose and treat. For a correct diagnosis, an array of information has to be processed and weighted. Successful treatment depends on the diagnosis, timing, and surgical strategy paired with treatment of the infectious agent. The complexity and interdisciplinarity needed cause difficulties concerning decision-making, the communication between disciplines, and the execution of a treatment strategy. The aim of this study was to develop a software platform to enhance the collection of information for the diagnosis of PJI, the interdisciplinary decision-making process, the communication between team members, and continuous evaluation of treatment. PATIENTS AND METHODS In regular planning sessions with an information technology (IT) specialist, a concept for an IT solution was chosen and the tool was designed in an interdisciplinary approach. RESULTS The tool has been used as a trial version since June 2017. It consists of 14 user interfaces with 431 items. A total of 117 patients with 118 infections have been entered and the strategy decided upon and communicated using 298 infection board documents outlining the treatment. The tool is now being used to organize the infections board agenda, schedule patient case discussions, document the relevant data and treatment plan, as well as communicate with the other teams involved in the treatment. CONCLUSION Using the developed tool enables the infections team to work collaboratively and under division of labor on each case, rendering the work flow more efficient for each team member.
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Affiliation(s)
- Christian Suren
- Department for Orthopedics and Sports Orthopedics, Technical University Munich, Munich, Germany
| | - Susanne Feihl
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University Munich, Munich, Germany
| | - Christiane Querbach
- Apotheke, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Patrick Rämer
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University Munich, Munich, Germany
| | - Florian Pohlig
- Department for Orthopedics and Sports Orthopedics, Technical University Munich, Munich, Germany
| | - Jakob Thurner
- Department for Orthopedics and Sports Orthopedics, Technical University Munich, Munich, Germany
| | - Rudolf Bernard
- Apotheke, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Dirk Busch
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University Munich, Munich, Germany
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8
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Hadano Y, Matsumoto T. Infectious disease consultations in a Japanese tertiary care teaching hospital: a retrospective review of 508 cases. BMC Health Serv Res 2018; 18:983. [PMID: 30567542 PMCID: PMC6300025 DOI: 10.1186/s12913-018-3802-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 12/09/2018] [Indexed: 11/10/2022] Open
Abstract
Objective Limited epidemiological data are available at tertiary care teaching hospitals in Japan. We reviewed infectious disease (ID) consultations in a tertiary acute care teaching hospital in Japan. Methods This is a retrospective review of the ID consultations from October 2016 to December 2017. The demographic data, such as requesting department, consultation wards, and final diagnosis, were analyzed. Results There were 508 ID consultations during the 15-month study period. Among the 508 consultations, 201 cases (39.6%) were requested from the internal medicine department and 307 cases (60.4%) were requested from departments other than internal medicine. The most frequent requesting departments were Surgery (n = 102, 20.1%), Pulmonary Medicine (n = 41, 8.1%), and Plastic Surgery (n = 35, 6.7%). The most common diagnoses were intra-abdominal (n = 81, 16.0%), respiratory (n = 62, 12.2%), and skin and soft tissue infections (n = 59, 11.6%). ID consultations for disease diagnosis and management were more frequent in the internal medicine group than in the non-internal medicine group (37 cases, 20.8% vs. 40 cases, 13.7%, p = 0.046), and the number of requests for consultations for noninfectious diseases at the time of final diagnosis was higher in the internal medicine group than in the non-internal medicine group (21 cases, 11.8% vs. 16 cases, 5.5%, p = 0.0153). Conclusion Some physicians prefer ID specialists to identify and solve various medical problems. Internists had a greater tendency to request consultations for diagnostic problems, and noninfectious disease specialists have more requests for consultation at the point of final diagnosis. The role of ID specialists is expanding, from individual patient management to antibiotic stewardship, antibiotic prophylaxis, and development of and adherence to antibiotic protocol implementation based on the hospital’s microbial susceptibility and infection control. Although the number of specialists is limited in Japan, ID services now play an important role for achieving a good outcome in patient management.
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Affiliation(s)
- Yoshiro Hadano
- Department of Infectious Diseases, St. Mary's Hospital, 422 Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan. .,Biostatistics Center, Kurume University School of Medicine, Kurume, Japan.
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Schmidt-Hieber M, Christopeit M, Schalk E. Infektionen bei Patienten mit hämatologisch-onkologischen Erkrankungen. Notf Rett Med 2017. [DOI: 10.1007/s10049-016-0257-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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10
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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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11
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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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12
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Turtle L, Jung A, Beeching NJ, Cocker D, Davies GR, Nicolson A, Beadsworth MB, Miller AR, Solomon T. An integrated model of care for neurological infections: the first six years of referrals to a specialist service at a university teaching hospital in Northwest England. BMC Infect Dis 2015; 15:387. [PMID: 26399536 PMCID: PMC4581475 DOI: 10.1186/s12879-015-1109-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 09/02/2015] [Indexed: 11/27/2022] Open
Abstract
Background A specialist neurological infectious disease service has been run jointly by the departments of infectious disease and neurology at the Royal Liverpool University Hospital since 2005. We sought to describe the referral case mix and outcomes of the first six years of referrals to the service. Methods Retrospective service review. Results Of 242 adults referred to the service, 231 (95 %) were inpatients. Neurological infections were confirmed in 155 (64 %), indicating a high degree of selection before referral. Viral meningitis (35 cases), bacterial meningitis (33) and encephalitis (22) accounted for 38 % of referrals and 61 % of confirmed neurological infections. Although an infrequent diagnosis (n = 19), neurological TB caused the longest admission (median 23, range 5 – 119 days). A proven or probable microbiological diagnosis was found in 100/155 cases (64.5 %). For the whole cohort, altered sensorium, older age and longer hospital stay were associated with poor outcome (death or neurological disability); viral meningitis was associated with good outcome. In multivariate analysis altered sensorium remained significantly associated with poor outcome, adjusted odds ratio 3.04 (95 % confidence interval 1.28 – 7.22, p = 0.01). Conclusions A service of this type provides important specialist care and a focus for training and clinical research on complex neurological infections.
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Affiliation(s)
- Lance Turtle
- Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool, L69 7BE, UK. .,Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK. .,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, L69 7BE, UK.
| | - Agam Jung
- Leeds General Infirmary, Leeds, LS1 3EX, UK.
| | - Nick J Beeching
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK. .,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, L69 7BE, UK. .,Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Derek Cocker
- Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool, L69 7BE, UK. .,Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK.
| | - Gerry R Davies
- Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool, L69 7BE, UK. .,Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK.
| | - Andy Nicolson
- Walton Centre for Neurology and Neurosurgery NHS Foundation Trust, Liverpool, L9 7LJ, UK.
| | - Michael Bj Beadsworth
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK. .,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, L69 7BE, UK.
| | - Alastair Ro Miller
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK.
| | - Tom Solomon
- Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool, L69 7BE, UK. .,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, L69 7BE, UK. .,Walton Centre for Neurology and Neurosurgery NHS Foundation Trust, Liverpool, L9 7LJ, UK.
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Marks M, Pollara G, Miller D, Bhatt S, Reynolds C, Gant V, Noursadeghi M. elCID: An electronic Clinical Infection Database to support integrated clinical services and research in infectious diseases. J Infect 2015; 71:402-405. [PMID: 25892135 PMCID: PMC4868136 DOI: 10.1016/j.jinf.2015.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 04/05/2015] [Accepted: 04/10/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
- The Hospital for Tropical Diseases, Mortimer Market Centre, Mortimer Market, Capper Street, London, UK
| | - Gabriele Pollara
- Department of Microbiology, University College London Hospital, 235 Euston Road, London, UK
- Division of Infection and Immunity, University College London, Cruciform Building, Gower Street, London, UK
| | - David Miller
- Open Health Care UK, Unit 3 127 Stoke Newington Road, London, UK
| | - Sonia Bhatt
- Division of Infection and Immunity, University College London, Cruciform Building, Gower Street, London, UK
| | - Carl Reynolds
- Open Health Care UK, Unit 3 127 Stoke Newington Road, London, UK
| | - Vanya Gant
- Division of Infection and Immunity, University College London, Cruciform Building, Gower Street, London, UK
| | - Mahdad Noursadeghi
- Department of Microbiology, University College London Hospital, 235 Euston Road, London, UK
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14
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Burden and spectrum of infectious disease in Germany 2009-2014: a multicentre study from Berlin's Municipal Hospitals. Infection 2015; 44:187-95. [PMID: 26311655 DOI: 10.1007/s15010-015-0834-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/17/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE This study aimed at assessing the burden and spectrum of infectious diseases (ID) in a Metropolitan population in Germany. METHODS A discharge database using ICD-10 codes enabled the identification of hospitalizations with infection-related diagnoses. All hospital admissions between 2009 and 2014 were analysed from 9 municipal hospitals serving approximately one-third of an urban population of 3.5 million people. RESULTS We identified 114,168 admissions with a primary (first-listed) ID diagnosis and 220,483 admissions with any-listed ID diagnosis, accounting for 8.9 % [95 % confidence interval (CI) 8.9-9.0 %] and 17.2 % (95 % CI 17.1-17.3) of all 1,284,559 admissions, respectively. Annually, 439,837 bed-days (range 413,707-488,520) were occupied by patients with an ID diagnosis, utilizing 22.8 % of total bed capacity. The median length of stay for patients with primary ID diagnosis and secondary ID diagnosis was 6 days (IQR 3-11) and 10 days (IQR 5-19), respectively. The most common diagnosis across all age groups was "pneumonia" (22.8 and 16.2 % of ID admissions as primary and secondary diagnosis, respectively). In-hospital mortality was 6.8 % (95 % CI 6.6-6.9) and 8.9 % (95 % CI 8.7-9.1) for ID as primary and secondary diagnosis, respectively. CONCLUSION Infectious diseases contribute significantly to the overall burden of disease in a health system caring for an urban German population. In view of the magnitude of ID's contribution, establishing more specialists in ID medicine and adjusting the reimbursements for managing infection-related admissions should be made a public health priority in Germany.
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15
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Fantoni M, Murri R, Scoppettuolo G, Fabbiani M, Ventura G, Losito R, Berloco F, Spanu T, Sanguinetti M, Cauda R. Resource-saving advice from an infectious diseases specialist team in a large university hospital: an exportable model? Future Microbiol 2015; 10:15-20. [PMID: 25598334 DOI: 10.2217/fmb.14.99] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
AIM To assess epidemiological features of patients for which a consultation by the infectious diseases consultation team was required, and the rate of clinical advice that led to resource-saving advice (R-SA): discontinuation of inappropriate therapy or prophylaxis, de-escalation and switch from parenteral to oral therapy. MATERIALS & METHODS An infectious diseases consultation team was implemented in a 1100-bed university hospital in Italy. RESULTS The most frequent infections for which an infectious diseases consultancy was required were pneumonia, bloodstream infections (17% by Candida) and urinary tract infections. In 828 patients (41.4%), interventions with the possibility of R-SA were suggested. CONCLUSION Resource-saving advices were possible in 41% of cases. Recent surgery, having a central venous catheter, bloodstream, abdominal, surgical site or bone and joint infections were correlated to a higher probability of receiving R-SA.
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Affiliation(s)
- Massimo Fantoni
- Institute of Infectious Diseases, Risk Management Unit, Institute of Microbiology, Catholic University of Rome, Rome, Italy
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