Resource-Saving Advice From an Infectious Diseases Specialist Team in a Large University Hospital: An Exportable Model?

Massimo Fantoni; Rita Murri; Giancarlo Scoppettuolo; Massimiliano Fabbiani; Giulio Ventura; Raffaella Losito; Filippo Berloco; Teresa Spanu; Maurizio Sanguinetti; Roberto Cauda

Disclosures

Future Microbiol. 2015;10(1):15-20. 

In This Article

Abstract and Introduction

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.

Introduction

Earlier diagnosis and optimized treatment of infectious diseases (IDs) have been largely associated to an improved survival and favorable outcomes.[1–3]

Several studies showed that antibiotic stewardship programs led to overall cost savings, decreased use of inappropriate antibiotics, reduced length of hospital stay and reduced antibiotic resistance while optimizing clinical outcomes.[4–6] However, the majority of these studies were done on very ill patients admitted to intensive care units. The magnitude of interventions leading to saving resources and the clinical situations for which ID consultation can be done in hospitalized patients not admitted in intensive care units are not completely clear.

This study was conducted to describe the epidemiological features of patients for which a consultation by the ID specialist team was required. As an indirect description of the antibiotic stewardship activity, we measured the rate of clinical advice that led to resource-saving interventions, and, particularly, the advice that contributed to limit antibiotic overuse.

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