Impact of an infection consultation service for bacteraemia on clinical management and use of resources

Abstract

Since 1993, the infection consultation service for bacteraemia has seen 310 patients in the Medical and Surgical Directorates at Ninewells Hospital and Kings Cross Hospital. A random sample of 100 was audited. Case-notes were incomplete for five patients, leaving 95 fully-audited patients. Clinical outcome measures were death from infection, and readmission within 2 weeks of discharge. Initial treatment was inconsistent with antibiotic policy in 46 patients (48%). Antibiotic treatment was changed in 37 (80%) of these patients: increased in intensity in 19 (41%) and decreased in 18 (39%). Changes were also made in 30 (61%) of the 49 patients whose initial treatment was consistent with sepsis policy-increased in seven (14%) and decreased in 23 (47%). Median daily antibiotic costs were lowered in patients whose initial treatment was consistent with sepsis policy (pounds 10.10 vs. pounds 7.28, p = 0.0274). However, in the other patients, savings were balanced by increases (p = 0.7696). Consultation required one consultant session per week (3.5 h) and the audit required an additional 16 consultant sessions. Seven patients died, but only one death was directly related to infection. Six patients were readmitted to hospital within 2 weeks, in three due to recurrence of infection. Changes to treatment were recommended in the majority of patients, regardless of whether initial treatment complied with the sepsis policy. The service primarily redistributed resources rather than reducing costs. A fully audited service requires considerable consultant time, but we believe such time is well spent.

Antimicrobial Expenditures and Usage at Four University Hospitals

“…[18]. In a number of pre-and post-intervention comparisons, some of the proposed strategies and the implementation of guidelines have been reported as successful in reducing inadequate drug prescribing and expenses for antimicrobials [19][20][21][22][23][24][25][26][27]. However, true cost savings have been difficult to estimate given the multiplicity of confounding variables and the lack of control data of cost variation over time.…”

Formal adult infectious disease specialist consultations in the outpatient setting at a comprehensive cancer center (1998–2008): Diverse and impactful

“…Various studies have addressed the profound value of these consultations regarding infectious complications in the inpatient setting [8,[11][12][13][14][15][16][17][18][19]. To the best of our knowledge, this is the first study to address the impact of ID specialist consultations in an outpatient setting in a comprehensive cancer center, an area where the literature is scarce [9,20].…”

“…The median number of evaluations per patient was two (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], which was almost equal to that in a series of outpatients reported by Grupper and Potasman [9]. In the most comprehensive study performed on a larger scale, Yinnon [17] suggested that an average of one or two follow-up visits after the first ID specialist consultation is optimal and that the impact of subsequent visits decreases; likely exceptions to this are consultations regarding critically ill patients in intensive care, hematology, and transplantation units.…”

Der Wert der klinischen Infektiologie

“…Die Mor ta li tät der Sep sis nahm in den letz ten 2-3 De ka den dras tisch ab [5,10,11,12,13,14]. In ei ner ei ge nen Stu die wur den 103 Pa ti en ten mit ei ner Sep sis un ter sucht.…”