Infectious disease specialist consultations in a Japanese cancer center: a retrospective review of 776 cases

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.

Effects of infectious disease consultation and antimicrobial stewardship program at a Japanese cancer center: An interrupted time-series analysis

“…Additionally, this may be because the ASP and ID consultations resulted in appropriate interventions and management of cases with difficult diagnoses and treatments. Most cancer centers in Japan do not have cross-organ departments such as the Department of General Internal Medicine; the Department of ID plays a part in this role [ 5 ]. It is possible that these activities increased the satisfaction of the oncologists; consequently, they became more compliant with ASP.…”

“…Patients with cancer, especially those with hematologic malignancies or severe neutropenia and those who undergo hematopoietic stem cell transplantation, frequently develop serious infections and receive multiple rounds of antimicrobial therapy during the progression of their underlying disease [ 3 , 4 ]. In patients with cancer, appropriate diagnosis and management of infection are frequently challenging due to the subtle or atypical presentation of infections [ 5 , 6 ]; therefore, substantial amounts of antimicrobials are used in these patients [ 7 ]. Carbapenems (CAR) are commonly prescribed for infections in patients with malignancies.…”

Outcomes of General Internal Medicine Consultations for Diagnosis from Specialists in a Tertiary Hospital: A Retrospective Observational Study

“…Second, we did not have some specialty departments, such as the department of infectious diseases, which deals with patients with fever or inflammation of undetermined origin. 13 , 33 , 34 This would increase the percentage of fever and elevated C-reactive protein in CCs, and might have affected the results. Third, the rate of definite new diagnoses with the agreement of the two researchers was relatively low (approximately 20%).…”

“… 2 , 5 Indeed, a previous study showed that approximately 10% of infectious disease consultations from other specialty departments associated with fever or inflammation of undetermined origin were due to non-infectious diseases. 13 In such a situation, generalists can work as “diagnostic medicine consultants” for undiagnosed health problems to improve patient experience and reduce healthcare costs. Previous studies have demonstrated the diagnostic advantages of generalists in primary and secondary care settings, and the rate of new diagnoses was approximately 10%; 14 , 15 however, research on referrals from specialists to generalists in tertiary care settings (ie, facilities providing highly technical and specialized care for patients with unusually severe, complex, or uncommon health problems) 16 , 17 is limited.…”

Infectious diseases consultations from general internal medicine physicians in Japan: A descriptive single-center study

“…However, there are only a few infectious disease specialists (IDSs) in Japan. [4][5][6][7] This means that the majority of hospitals and tertiary care centers do not have IDSs, especially those in rural areas. According to a report in 2019, there are only 1491 board-certified IDSs in Japan, which can be translated to 1.2 specialists per 100,000 population, compared to that of 2.8 in the United States.…”