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

BMC Infectious Diseases

Research Article

José-Antonio Amado¹  Manuel Gómez-Fleitas²  Natividad Benito³  Gabriela Saravia⁴  María-Carmen Fariñas⁴  Jorge Calvo-Montes⁵  Luis Martínez-Martínez⁶  Lorenzo Aguilar⁷  Juan-José Martínez-Garde⁸  Ramón Agüero⁹  Concepción Fariñas-Alvarez^1,10 

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

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

DOI  :  10.1186/1471-2334-12-292

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

来源: Springer

【 摘 要 】

BackgroundConsultation 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.MethodsA 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.ResultsA 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.ConclusionsAdherence 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 registrationCurrent Controlled Trials ISRCTN83234896. http://www.controlled-trials.com/isrctn/sample_documentation.asp

【 授权许可】

CC BY   
© Fariñas et al.; licensee BioMed Central Ltd. 2012