Adherence to recommendations by infectious disease consultants and its influence on outcomes of intravenous antibiotic-treated hospitalized patients

BMC Infectious Diseases

Manuel Gómez-Fleitas^1,10  Luis Martínez-Martínez¹  José-Antonio Amado²  Ramón Agüero⁶  Lorenzo Aguilar⁷  Concepción Fariñas-Alvarez⁴  Juan-José Martínez-Garde⁸  Natividad Benito⁹  Jorge Calvo-Montes³  Gabriela Saravia⁵  María-Carmen Fariñas⁵ 

[1] Department of Molecular Biology, University of Cantabria, Avda. Cardenal Herrera Oria s/n, 39011, Santander, Spain;Endocrinology Department, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain;Microbiology Department, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain;Preventive Medicine Department, Hospital Sierrallana, BªGanzo s/n, 39300, Torrelavega, Cantabria, Spain;Infectious Diseases Unit, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008 Santander, Spain;Pneumology Department, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain;Microbiology Department, School of Medicine Universidad Complutense, Avda. Complutense s/n, 28040, Madrid, Spain;Pharmacy Department, Hospital Universitario Marques de Valdecilla, Av. Valdecilla s/n, 39008, Santander, Spain;Infectious Diseases Unit, Hospital Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain;General Surgery Department, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain

关键词: Antimicrobial stewardship;    Antibiotic management;    Antibiotic use;    Antibiotic intervention;    Infectious diseases specialists;   

Others  :  1159598
DOI  :  10.1186/1471-2334-12-292

 received in 2012-02-24, accepted in 2012-11-07,  发布年份 2012

【 摘 要 】

Background

Consultation to infectious diseases specialists (ID), although not always performed by treating physicians, is part of hospital’s daily practice. This study analyses adherence by treating physicians to written ID recommendations (inserted in clinical records) and its effect on outcome in hospitalized antibiotic-treated patients in a tertiary hospital in Spain.

Methods

A prospective, randomized, one-year study was performed. Patients receiving intravenous antimicrobial therapy prescribed by treating physicians for 3 days were identified and randomised to intervention (insertion of written ID recommendations in clinical records) or non-intervention. Appropriateness of empirical treatments (by treating physicians) was classified as adequate, inadequate or unnecessary. In the intervention group, adherence to recommendations was classified as complete, partial or non-adherence.

Results

A total of 1173 patients were included, 602 in the non-intervention and 571 in the intervention group [199 (34.9%) showing complete adherence, 141 (24.7%) partial adherence and 231 (40.5%) non-adherence to recommendations]. In the multivariate analysis for adherence (R² Cox=0.065, p=0.009), non-adherence was associated with prolonged antibiotic prophylaxis (p=0.004; OR=0.37, 95%CI=0.19-0.72). In the multivariate analysis for clinical failure (R² Cox=0.126, p<0.001), Charlson index (p<0.001; OR=1.19, 95%CI=1.10-1.28), malnutrition (p=0.006; OR=2.00, 95%CI=1.22-3.26), nosocomial infection (p<0.001; OR=4.12, 95%CI=2.27-7.48) and length of hospitalization (p<0.001; OR=1.01, 95%CI=1.01-1.02) were positively associated with failure, while complete adherence (p=0.001; OR=0.35, 95%CI=0.19-0.64) and adequate initial treatment (p=0.010; OR=0.39, 95%CI=0.19-0.80) were negatively associated.

Conclusions

Adherence to ID recommendations by treating physicians was associated with favorable outcome, in turn associated with shortened length of hospitalization. This may have important health–economic benefits and stimulates further investigation.

Trial registration

Current Controlled Trials ISRCTN83234896.http://www.controlled-trials.com/isrctn/sample_documentation.asp webcite

【 授权许可】

   
2012 Fariñas et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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