1
|
Hadano Y, Ohwaki K, Suyama A, Miura A, Fujii S, Suzuki Y, Tomoda Y, Awaya Y. The Changes in Broad-spectrum Antimicrobial Consumption during the COVID-19 Pandemic in a Japanese Acute Tertiary-care Hospital: An Interrupted Time-series Analysis. Intern Med 2024; 63:2125-2130. [PMID: 38104990 DOI: 10.2169/internalmedicine.2868-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Objective The novel coronavirus disease 2019 (COVID-19) pandemic has spread worldwide, and hospitals in Japan have been forced to respond to the situation. This study evaluated the broad-spectrum antimicrobial use before and during the COVID-19 pandemic in an acute tertiary-care hospital. Methods This single-center, retrospective study was conducted between January 2019 and June 2021. Patients We reviewed patients treated with three broad-spectrum antipseudomonal agents: carbapenems, tazobactam/piperacillin, and cefepime. Monthly aggregated hospital antimicrobial consumption was measured as days of therapy (DOTs) per 1,000 patient-days, and the monthly incidences of Clostridioides difficile infection (CDI), multidrug-resistant Pseudomonas aeruginosa (MRPA), and carbapenemase-producing Enterobacteriaceae (CPE) were recorded. Results The median monthly carbapenem-DOTs during the pre-pandemic and pandemic era were 8.4 and 8.2 per 1,000 patient-days, respectively. A time-series analysis showed non-significant changes in the level between periods (coefficients: 2.08; 95% confidence interval [CI]: -2.9 to 7.0; p=0.44). No change in the trend of monthly carbapenem-DOTs was observed after intervention. No post-intervention changes in the incidence of MRPA or CPE were observed; however, the trend in the incidence of CDI per 1,000 patient-days significantly differed between the two periods (coefficient: -0.04; 95% CI: -0.07, 0.00; p=0.01), and a downward trend was observed in the monthly CDI incidence during the COVID-19 period. Conclusion The consumption of broad intravenous antimicrobial agents has not changed significantly during the pandemic. We need to maintain the quality of medical care, including antimicrobial stewardship, even in specialized resource-limited facilities during a pandemic.
Collapse
Affiliation(s)
- Yoshiro Hadano
- Teikyo University Graduate School of Public Health, Japan
- Antimicrobial Stewardship Team, Itabashi Chuo Medical Center, Japan
- Division of Infection Control and Prevention, Shimane University Hospital, Japan
| | | | - Asuka Suyama
- Department of Pharmacy, Itabashi Chuo Medical Center, Japan
| | - Ayako Miura
- Department of Clinical Laboratory, Itabashi Chuo Medical Center, Japan
| | - Shigeo Fujii
- Department of Clinical Laboratory, Itabashi Chuo Medical Center, Japan
| | - Yoshiko Suzuki
- Department of Nursing, Itabashi Chuo Medical Center, Japan
| | - Yoshitaka Tomoda
- Department of Medicine, Division of General Medicine Itabashi Chuo Medical Center, Japan
- Department of Medicine, Division of Pulmonary Medicine, Itabashi Chuo Medical Center, Japan
| | - Yukikazu Awaya
- Department of Medicine, Division of General Medicine Itabashi Chuo Medical Center, Japan
- Department of Medicine, Division of Pulmonary Medicine, Itabashi Chuo Medical Center, Japan
| |
Collapse
|
2
|
Hirabayashi A, Yahara K, Oka K, Kajihara T, Ohkura T, Hosaka Y, Shibayama K, Sugai M, Yagi T. Comparison of disease and economic burden between MRSA infection and MRSA colonization in a university hospital: a retrospective data integration study. Antimicrob Resist Infect Control 2024; 13:27. [PMID: 38424606 PMCID: PMC10905874 DOI: 10.1186/s13756-024-01383-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/10/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Although there is a growing concern and policy regarding infections or colonization caused by resistant bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), the prognosis of MRSA infections compared to that of methicillin-susceptible Staphylococcus aureus (MSSA) infections remains controversial. Moreover, there have not been any studies comparing both the burden of disease and its impact on the healthcare economy between MRSA infection and colonization while adjusting for confounding factors. These comparisons are crucial for developing effective infection control measures and healthcare policies. We aimed to compare the disease and economic burden between MRSA and MSSA infections and between MRSA infection and colonization. METHODS We retrospectively investigated data of 496 in-patients with MRSA or MSSA infections and of 1178 in-patients with MRSA infections or MRSA colonization from a university hospital in Japan from 2016 to 2021. We compared in-hospital mortality, length of stay, and hospital charges between in-patients with MRSA and MSSA infections and those with MRSA infections and MRSA colonization using multiple regressions. We combined surveillance data, including all microbiological test results, data on patients with infections, treatment histories, and clinical outcomes, to create the datasets. RESULTS There was no statistically significant difference in in-hospital mortality rates between matched MRSA vs. MSSA infections and MRSA infection vs. colonization. On the contrary, the adjusted effects of the MRSA infection compared to those of MSSA infection on length of stay and hospital charges were 1.21-fold (95% confidence interval [CI] 1.03-1.42, P = 0.019) and 1.70-fold (95% CI 1.39-2.07, P < 0.00001), respectively. The adjusted effects of the MRSA infection compared to those of MRSA colonization on length of stay and hospital charges were 1.41-fold (95% CI 1.25-1.58, P < 0.00001) and 1.53-fold (95% CI 1.33-1.75, P < 0.00001), respectively. Regarding confounding factors, hemodialysis or hemofiltration was consistently identified and adjusted for in the multiple regression analyses comparing MRSA and MSSA infections, as well as MRSA infection and MRSA colonization. CONCLUSIONS MRSA infection was associated with longer length of stay and higher hospital charges than both MSSA infection and MRSA colonization. Furthermore, hemodialysis or hemofiltration was identified as a common underlying factor contributing to increased length of stay and hospital charges.
Collapse
Affiliation(s)
- Aki Hirabayashi
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan.
| | - Koji Yahara
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan.
| | - Keisuke Oka
- Department of Infectious Diseases, Nagoya University Hospital, Aichi, Japan
| | - Toshiki Kajihara
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Teruko Ohkura
- Department of Medical Technique, Nagoya University Hospital, Aichi, Japan
| | - Yumiko Hosaka
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Keigo Shibayama
- Department of Bacteriology, Nagoya University Graduate School of Medicine, Aichi , Japan
| | - Motoyuki Sugai
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tetsuya Yagi
- Department of Infectious Diseases, Nagoya University Hospital, Aichi, Japan.
| |
Collapse
|
3
|
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.
Collapse
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
| | | |
Collapse
|
4
|
Hadano Y, Suyama A, Hijikata T, Miura A, Fujii S, Suzuki Y, Tomoda Y, Awaya Y. The importance of infectious disease specialists consulting on a weekly basis in a Japanese tertiary care hospital: A retrospective observational study. Medicine (Baltimore) 2023; 102:e32628. [PMID: 36607851 PMCID: PMC9829282 DOI: 10.1097/md.0000000000032628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Limited data are available regarding part-time infectious disease consultations (IDCs) and their importance in tertiary care teaching hospitals in Japan. This is a retrospective review of IDCs from June 2016 to March 2021 and describes IDC services provided by part-time infectious disease specialists once a week for 4 hours, and their impact on the quality of medical care, including antimicrobial stewardship. Data, such as the requesting department, requesting reasons, and final diagnoses, were analyzed. In April 2018, part-time infectious disease specialists launched consultation services and attended an antimicrobial stewardship team conference. Meropenem, tazobactam/piperacillin, and cefepime monthly days of therapy (DOT) were calculated to assess the effect of each intervention; a pre-post analysis was conducted using the Kruskal-Wallis test. Additional quality improvement (QI) projects related to infectious diseases were implemented. There were 237 IDCs during the study period. Consultations were mostly requested by the General Internal Medicine, Emergency Medicine, and Cardiology departments. The most common diagnoses were bone/joint, respiratory, and genitourinary infections. Infectious disease services, even on a part-time basis, achieve good outcomes in patient management, antimicrobial stewardship, and QI projects. DOT/1000 patient-days were reduced for meropenem and cefepime, while it increased for tazobactam/piperacillin. The DOT/1000 patient-days for the 3-antipseudomonal agents significantly decreased during this period. After implementing the QI tetanus vaccination project in the Emergency Room, the number of tetanus toxoid vaccinations per month increased.
Collapse
Affiliation(s)
- Yoshiro Hadano
- Antimicrobial Stewardship Team, Itabashi Chuo Medical Centre, Itabashi-ku, Tokyo, Japan
- Division of Infection Control and Prevention, Shimane University Hospital, Izumo Shimane, Japan
- * Correspondence: Yoshiro Hadano, Division of Infection Control and Prevention, Shimane University Hospital, 89-1 Enyacho, Izumo Shimane 693-8501, Japan (e-mail: )
| | - Asuka Suyama
- Department of Pharmacy, Itabashi Chuo Medical Center, Itabashi-ku, Tokyo, Japan
| | - Toshiyuki Hijikata
- Department of Emergency Medicine, Itabashi Chuo Medical Centre, Itabashi-ku, Tokyo, Japan
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Kanagawa, Japan
| | - Ayako Miura
- Department of Clinical Laboratory, Itabashi Chuo Medical Centre, Itabashi-ku, Tokyo, Japan
| | - Shigeo Fujii
- Department of Clinical Laboratory, Itabashi Chuo Medical Centre, Itabashi-ku, Tokyo, Japan
| | - Yoshiko Suzuki
- Department of Nursing, Itabashi Chuo Medical Centre, Itabashi-ku, Tokyo, Japan
| | - Yoshitaka Tomoda
- Department of Medicine, Division of Pulmonary Medicine, Itabashi Chuo Medical Centre, Itabashi-ku, Tokyo, Japan
- Department of Medicine, Division of General Medicine Itabashi Chuo Medical Centre, Itabashi-ku, Tokyo, Japan
| | - Yukikazu Awaya
- Department of Medicine, Division of Pulmonary Medicine, Itabashi Chuo Medical Centre, Itabashi-ku, Tokyo, Japan
- Department of Medicine, Division of General Medicine Itabashi Chuo Medical Centre, Itabashi-ku, Tokyo, Japan
| |
Collapse
|
5
|
Kawamura R, Harada Y, Yokose M, Hanai S, Suzuki Y, Shimizu T. Survey of Inpatient Consultations with General Internal Medicine Physicians in a Tertiary Hospital: A Retrospective Observational Study. Int J Gen Med 2023; 16:1295-1302. [PMID: 37081930 PMCID: PMC10112478 DOI: 10.2147/ijgm.s408768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/07/2023] [Indexed: 04/22/2023] Open
Abstract
Purpose The general internal medicine (GIM) department can be an effective diagnostic coordinator for undiagnosed outpatients. We investigated the contribution of GIM consultations to the diagnosis of patients admitted to specialty departments in hospitals in Japan that have not yet adopted a hospitalist system. Patients and Methods This single-center, retrospective observational study was conducted at a university hospital in Japan. GIM consultations from other departments on inpatients aged ≥20 years, from April 2016 to March 2021, were included. Data were extracted from electronic medical records, and consultation purposes were categorized into diagnosis, treatment, and diagnosis and treatment. The primary outcome was new diagnosis during hospitalization for patients with consultation purpose of diagnosis or diagnosis and treatment. The secondary outcomes were the purposes of consultation with the Diagnostic and Generalist Medicine department. Results In total, 342 patients were included in the analysis. The purpose of the consultations was diagnosis for 253 patients (74%), treatment for 60 (17.5%), and diagnosis and treatment for 29 patients (8.5%). In 282 consultations for diagnosis and diagnosis and treatment, 179 new diagnoses were established for 162 patients (57.5%, 95% confidence interval [CI], 51.5-63.3). Conclusion The GIM department can function as a diagnostic consultant for inpatients with diagnostic problems admitted to other specialty departments in hospitals where hospitalist or other similar systems are not adopted.
Collapse
Affiliation(s)
- Ren Kawamura
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan
| | - Yukinori Harada
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan
| | - Masashi Yokose
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan
| | - Shogo Hanai
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan
| | - Yudai Suzuki
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan
- Correspondence: Taro Shimizu, Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan, Tel +8128286-1111, Email
| |
Collapse
|
6
|
Hadano Y, Kosaka S, Tomoda Y, Awaya Y, Kato R. Infectious diseases consultations from general internal medicine physicians in Japan: A descriptive single-center study. Medicine (Baltimore) 2022; 101:e31896. [PMID: 36451384 PMCID: PMC9704987 DOI: 10.1097/md.0000000000031896] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
In Japan, general internal medicine (GIM) physicians must be aware of frequently encountered infections because of the shortage of infectious disease (ID) specialists. However, there are currently no epidemiological data on this subject. This study aimed to describe the frequency and pattern of ID consultations requested by GIM physicians in Japan. This is a 3-year retrospective review of the ID consultations requested by GIM physicians in Japan at a community-based acute tertiary care teaching hospital in Tokyo from April 2018 to March 2021. Demographic data, such as reasons for consultation, causative organism, and final diagnoses, were collected. During the study period, ID consultations were requested by GIM physicians 128 times. The incidence rates of bacteremia and 30-day mortality were 65.6% (n = 84) and 3.1% (n = 4), respectively. The most common diagnostic classifications after ID consultation were bone/joint (24.2%, n = 31), respiratory (17.7%, n = 22), and cardiovascular infections (12.5%, n = 16). The most common final diagnoses were bacteremia (11.7%, n = 15), infective endocarditis (9.4%, n = 12), and vertebral osteomyelitis (7.8%, n = 10). This is the first study to describe the ID consultation cases requested by GIM physicians in Japan in a community-based acute tertiary care teaching hospital. Despite the shortage of ID specialists, GIM physicians covered a wide range of IDs, including bone/joint infections and infectious endocarditis, which require long-term care. ID and GIM physicians, including hospitalists, should cooperate to promote the quality of care and clinical management. Future multi-center studies with large numbers of clinical cases are needed to determine the ID clinical knowledge required by GIM physicians in Japan.
Collapse
Affiliation(s)
- Yoshiro Hadano
- Antimicrobial Stewardship Team, Itabashi Chuo Medical Center, Itabashi-ku, Japan
- Division of Infection Control and Prevention, Shimane University Hospital, Izumo, Japan
- * Correspondence: Yoshiro Hadano, Division of Infection Control and Prevention, Shimane University Hospital, 89-1 Enyacho, Izumo, Shimane 693-8501, Japan (e-mail: )
| | - Shintaro Kosaka
- Department of Medicine, Division of General Medicine, Itabashi Chuo Medical Center, Itabashi-ku, Japan
| | - Yoshitaka Tomoda
- Department of Medicine, Division of General Medicine, Itabashi Chuo Medical Center, Itabashi-ku, Japan
- Department of Medicine, Division of Pulmonary Medicine, Itabashi Chuo Medical Center, Itabashi-ku, Japan
| | - Yukikazu Awaya
- Department of Medicine, Division of General Medicine, Itabashi Chuo Medical Center, Itabashi-ku, Japan
- Department of Medicine, Division of Pulmonary Medicine, Itabashi Chuo Medical Center, Itabashi-ku, Japan
| | - Ryotaro Kato
- Department of Medicine, Division of General Medicine, Itabashi Chuo Medical Center, Itabashi-ku, Japan
| |
Collapse
|
7
|
Yokose M, Harada Y, Hanai S, Tomiyama S, Shimizu T. Outcomes of General Internal Medicine Consultations for Diagnosis from Specialists in a Tertiary Hospital: A Retrospective Observational Study. Int J Gen Med 2022; 15:7209-7217. [PMID: 36124102 PMCID: PMC9482410 DOI: 10.2147/ijgm.s378146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 09/07/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The data on the diagnostic contribution of general internal medicine (GIM) consultations for undiagnosed health problems from specialists are scarce. This study aims to explore the role of generalists as diagnostic medicine consultants in tertiary care settings. Patients and Methods We conducted a retrospective observational study at a Japanese university hospital. GIM consultations for diagnosis from other departments on outpatients aged ≧ 20 years from January 2018 to December 2020 were included. Data were extracted from electronic medical records. The primary outcome was new diagnosis rates. The secondary outcomes were new diagnosis rates with clinical significance and clinical outcomes at 90 days from the index visit. Results A total of 328 patients were included. The top five consulting departments were orthopedics (17.0%), cardiovascular (10.3%), otorhinolaryngology (8.8%), neurology (8.8%), and gastroenterology (7.9%). GIM identified 456 chief complaints (CCs), and the top five were fever (10.9%), abnormal laboratory results (8.3%), fatigue (5.9%), and pain (7.4%) or numbness (4.6%) in the extremities. There were 139 (104/328 patients: 31.8%) specialty consultations from GIM, and the top five departments were rheumatology (21.1%), gastroenterology (19.2%), orthopedics (9.6%), psychiatry (9.6%), and neurology (9.6%). In total, 277 new diagnoses were established in 232 patients (70.7%), and 203 patients had new diagnoses with clinical significance (61.8%). Clinical outcomes at 90 days from the time of the index visit were resolution/improvement (60.7%), unchanged/worsened (22.3%), and unknown (17.0%). Conclusion Over 70% of GIM consultations from other departments established new diagnoses with favorable outcomes in >60% of the patients.
Collapse
Affiliation(s)
- Masashi Yokose
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, 321-0293, Japan
| | - Yukinori Harada
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, 321-0293, Japan
| | - Shogo Hanai
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, 321-0293, Japan
| | - Shusaku Tomiyama
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, 321-0293, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, 321-0293, Japan
- Correspondence: Taro Shimizu, Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Kitakobayashi 880, Shimotsuga, Mibu, Tochigi, 321-0293, Japan, Tel +81 282 86-1111, Email
| |
Collapse
|
8
|
Romanò CL, Tsantes AG, Papadopoulos DV, Tsuchiya H, Benzakour T, Benevenia J, Del Sel H, Drago L, Mavrogenis AF. Infectious disease specialists and teamwork strategies worldwide: the World Association against Infection in Orthopedics and Trauma (WAIOT) and SICOT continue to cooperate in fighting musculoskeletal infections. SICOT J 2022; 8:E1. [PMID: 35969121 PMCID: PMC9377213 DOI: 10.1051/sicotj/2022031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/27/2022] [Indexed: 11/14/2022] Open
Abstract
Bone and joint infections are associated with a devastating global burden. The successful treatment of these infections requires a multidisciplinary approach between orthopedic surgeons and experts of different disciplines. This multidisciplinary approach has gained ground over the past decades in modern infection units as a more effective treatment strategy, yielding better outcomes regarding infection eradication rates, length of hospital stay, and overall cost of treatments. Additionally, preventing and managing musculoskeletal infections requires strong connections between medical associations, biological laboratories, and the pharmaceutical industry worldwide. In this context, SICOT and World Association against Infection in Orthopaedics and Trauma (WAIOT) relationships have been increasing. The present editorial article discusses the multidisciplinary approach for managing bone and joint infections worldwide, explores the controversies in practices in terms of training, area of expertise, and extent of clinical involvement, and emphasizes the role of societies in research, prevention and management of musculoskeletal infections. The purpose is to acknowledge what orthopedics can obtain from specialists dealing with bone and joint infections and to consolidate their practice to provide the best care for orthopedic patients.
Collapse
Affiliation(s)
- Carlo L Romanò
- Studio Medico Cecca-Romano - Corso Venezia, 20121 Milano, Italy
| | - Andreas G Tsantes
- Department of Microbiology, Saint Savvas Oncology Hospital, 115 22 Athens, Greece
| | | | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery - Graduate School of Medical Sciences, Kanazawa University, 920-0293 Kanazawa, Japan
| | | | - Joseph Benevenia
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Hernán Del Sel
- Department of Orthopaedics, British Hospital Buenos Aires, C1280 AEB Buenos Aires, Argentina
| | - Lorenzo Drago
- Clinical Microbiology, University of Milan, 20122 Milano, Italy
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 11527 Athens, Greece
| | | |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Itoh N, Hadano Y, Yamamoto Y, Terada N, Kurai H. Infectious disease specialist consultations in a Japanese cancer center: a retrospective review of 776 cases. BMC Health Serv Res 2020; 20:500. [PMID: 32493315 PMCID: PMC7268407 DOI: 10.1186/s12913-020-05380-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 05/28/2020] [Indexed: 12/05/2022] Open
Abstract
Background Little is known about the impact of infectious disease (ID) consultations on the management of patients with cancer. This study aimed to describe the consultation services provided by ID specialists to all departments in a comprehensive cancer center in Japan. Methods We conducted a retrospective review of ID consultations with adult patients at a comprehensive cancer center in Japan from April 2017 to March 2018. Results During the study period, 776 patients with cancer had an ID consultation. Of these, 414 (53.4%) were hospital inpatients. Reasons for the ID consultation comprised clinical management (n = 481, 62.0%), immunization (n = 272, 35.1%), and infection control (n = 23, 3.0%). Of the 474 ID consultations for diagnostic purposes, the most frequent condition was fever or elevated inflammatory markers of unknown origin (n = 125, 26.4%). The most frequent diagnoses after the diagnostic ID consultation were hepatobiliary infections (n = 97, 22.4%), respiratory infections (n = 89, 20.618.8%), and intra-abdominal infections (n = 71, 16.4%). The commonest reasons for immunization consultations were to prevent seasonal influenza (n = 193, 71.0%) and post-splenectomy vaccination (n = 58, 21.3%). The commonest reasons for infection control consultations were suspected tuberculosis or contact with tuberculosis (n = 11, 47.8%) and herpes zoster infection (shingles) (n = 7, 30.4%). Conclusions ID specialists play an important role in the clinical management of patients with cancer. ID physicians who work in cancer centers need to be specialized in treating IDs, diagnosing the causes of fevers of unknown origin, and controlling infection.
Collapse
Affiliation(s)
- Naoya Itoh
- Division of Infectious Diseases, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Yoshiro Hadano
- Department of Infection Control and Prevention, Tokyo Medical and Dental University Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yasumasa Yamamoto
- Division of Infectious Diseases, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Norihiko Terada
- Division of Infectious Diseases, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Hanako Kurai
- Division of Infectious Diseases, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan
| |
Collapse
|
11
|
Vasoo S, Chan M, Sendi P, Berbari E. The Value of Ortho-ID Teams in Treating Bone and Joint Infections. J Bone Jt Infect 2019; 4:295-299. [PMID: 31966961 PMCID: PMC6960030 DOI: 10.7150/jbji.41663] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Shawn Vasoo
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Monica Chan
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Parham Sendi
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel
- Department of Orthopaedics and Traumatology, University Hospital Basel, University of Basel
- Institute of Infectious Diseases, University of Bern, Bern, Switzerland
| | - Elie Berbari
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic College of Medicine, Rochester, MN, USA
| |
Collapse
|