COMMENTARY

Consulting an ID Specialist Saves Lives and Money

Paul G. Auwaerter, MD

Disclosures

April 12, 2018

Hello. I'm Paul Auwaerter with Medscape Infectious Diseases, speaking from the Division of Infectious Diseases at the Johns Hopkins University School of Medicine.

Like many cognitive specialties, the field of infectious diseases has been relatively less valued with respect to the work of its clinicians than other medical specialties and subspecialties. In this era of value-based care, which is becoming increasingly prominent, it has sometimes been difficult to measure how our consultation and practices lead to better patient outcomes and higher value, especially for inpatient care, where we aren't typically the primary attending physicians of record but instead we assist others to provide care.

The Infectious Diseases Society of America for a long while has maintained a host of resources to help articulate the value of infectious diseases care, as well as try to attribute some benefits that can be measured in terms of outcomes for our patients, and reductions in the cost of care.

Last year, Dan McQuillen and Ann MacIntyre published a very nice paper in the Journal of Infectious Diseases[1] that catalogues much of the literature, as well as thoughts about how our field can actually be very helpful.

A recent study in the Open Forum for Infectious Diseases[2] was published by Burnham and colleagues from Washington University and Barnes-Jewish Hospital in St Louis. I thought this paper deserved some notice. First of all, it was the only study to date to demonstrate considerable improvement in patient outcomes among patients infected with multiple drug-resistant organisms, including gram-negative pathogens, such as Enterobacteriaceae.

This paper, like others, also showed improvement in the treatment of Staphylococcus aureus infections. Infectious diseases consultation was associated with a hazard ratio [HR] reduction for 30-day mortality of about one half and for 1-year mortality, by one quarter. Very similar improvements were found in mortality from gram-negative Enterobacteriaceae infections (HR, 0.6) at 1 year, with an all-cause mortality HR of 0.25, which I thought was quite impressive.

This retrospective cohort study could have cofounders and bias, yet it is another arrow in the quiver that portrays the value of infectious disease specialists, in our increasingly complex environment where we have resistant organisms and where other physicians may not have the expertise to select optimal drug regimens or good durations, or avoid important toxicities, especially when patients are on a host of drugs and combinations. All of these increasingly fall within the bailiwick of infectious diseases, the people most capable of guiding a patient's care to these better outcomes.

This is important to show. We have resistant gram-negative infections and S aureus. Unfortunately, this study was not large enough to highlight even more problematic infections, such as Pseudomonas aeruginosa or Acinetobacter infections. This is what we have, and it is quite instrumental.

Along with a host of other papers, hopefully you can use these findings when arguing with those who hold the purse strings that fair value and compensation are important, because we bring great value for treating infectious diseases, especially patients who are difficult to care for.

Thanks very much for listening.

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