, Volume 40, Issue 5, pp 501–507 | Cite as

Clinical benefit of infectious diseases consultation: a monocentric prospective cohort study

  • A. de La Blanchardière
  • J. Boutemy
  • P. Thibon
  • J. Michon
  • R. Verdon
  • V. Cattoir
Clinical and Epidemiological Study



To determine the association of clinical outcomes with the adherence to Infectious Diseases Consultation (IDC) recommendations.


From March to August 2009, all patients hospitalized in our hospital, for whom an IDC was requested, were prospectively enrolled. The adherence to recommendations was ascertained after 72 h from the IDC. The primary objective of the study was to evaluate the clinical cure rate 1 month after the IDC, according to the adherence to IDC recommendations.


An IDC was requested for 258 inpatients. The infectious disease (ID) was most often non-severe (66 %), community-acquired (62 %), and already under treatment (47 %). IDC proposals were most often formulated via a formal consultation (57 %). Physicians’ adherence to IDC recommendations was 87 % for diagnostic tests and 90 % for antibiotherapy. In the multivariate analysis, severe infections and direct consultation were independently associated with increased odds of adherence to recommendations for performing diagnostic tests (odds ratios 5.4 and 4.0, respectively). The overall clinical cure rate was 84 % and this did not differ according to the adherence to IDC recommendations for diagnostic tests (84.3 vs. 71.4 %, p = 0.15) and antimicrobial treatment (84.8 vs. 77.8 %, p = 0.34).


Some limitations of the study may explain the lack of evidence of a clinical benefit, such as the very high level of adherence to IDC recommendations and the low proportion of severe infections. However, clinical improvement was always better when recommendations were followed. Therefore, further larger randomized multicentric studies including more patients suffering from more severe IDs may be needed in order to demonstrate a clinical impact.


Infectious diseases consultation IDC Adherence to recommendations Clinical outcomes 


Conflict of interest

No conflicts of interest were reported by any of the authors. No funding was received for this work.


  1. 1.
    Sarkar P, Gould IM. Antimicrobial agents are societal drugs: how should this influence prescribing? Drugs. 2006;66:893–901.PubMedCrossRefGoogle Scholar
  2. 2.
    Scheckler WE, Bennett JV. Antibiotic usage in seven community hospitals. JAMA. 1970;213:264–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Roberts AW, Visconti JA. The rational and irrational use of systemic antimicrobial drugs. Am J Hosp Pharm. 1972;29:828–34.PubMedGoogle Scholar
  4. 4.
    Reimann HA. The misuse of antimicrobics. Med Clin North Am. 1961;45:849–56.PubMedGoogle Scholar
  5. 5.
    Marr JJ, Moffet HL, Kunin CM. Guidelines for improving the use of antimicrobial agents in hospitals: a statement by the Infectious Diseases Society of America. J Infect Dis. 1988;157:869–76.PubMedCrossRefGoogle Scholar
  6. 6.
    Kislak JW, Eickhoff TC, Finland M. Hospital-acquired infections and antibiotic usage in the Boston city hospital—January, 1964. N Eng J Med. 1964;271:834–5.CrossRefGoogle Scholar
  7. 7.
    John JF Jr, Fishman NO. Programmatic role of the infectious diseases physician in controlling antimicrobial costs in the hospital. Clin Infect Dis. 1997;24:471–85.PubMedCrossRefGoogle Scholar
  8. 8.
    Cosgrove SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis. 2006;42:S82–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Roberts RR, Hota B, Ahmad I, Scott RD 2nd, Foster SD, Abbasi F, Schabowski S, Kampe LM, Ciavarella GG, Supino M, Naples J, Cordell R, Levy SB, Weinstein RA. Hospital and societal costs of antimicrobial-resistant infections in a Chicago teaching hospital: implications for antibiotic stewardship. Clin Infect Dis. 2009;49:1175–84.PubMedCrossRefGoogle Scholar
  10. 10.
    Spencer RC. The role of antimicrobial agents in the aetiology of Clostridium difficile-associated disease. J Antimicrob Chemother. 1998;41:21–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Ghantoji SS, Sail K, Lairson DR, DuPont HL, Garey KW. Economic healthcare costs of Clostridium difficile infection: a systematic review. J Hosp Infect. 2010;74:309–18.PubMedCrossRefGoogle Scholar
  12. 12.
    McFarland LV. Update on the changing epidemiology of Clostridium difficile-associated disease. Nat Clin Pract Gastroenterol Hepatol. 2008;5:40–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Dellit TH, Owens RC, McGowan JE Jr, Gerding DN, Weinstein RA, Burke JP, Huskins WC, Paterson DL, Fishman NO, Carpenter CF, Brennan PJ, Billeter M, Hooton TM. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44:159–77.PubMedCrossRefGoogle Scholar
  14. 14.
    Davey P, Brown E, Fenelon L, Finch R, Gould I, Hartman G, Holmes A, Ramsay C, Taylor E, Wilcox M, Wiffen P. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2005;(4):CD003543.Google Scholar
  15. 15.
    Patel D, Lawson W, Guglielmo BJ. Antimicrobial stewardship programs: interventions and associated outcomes. Expert Rev Anti Infect Ther. 2008;6:209–22.PubMedCrossRefGoogle Scholar
  16. 16.
    Fowler VG Jr, Sanders LL, Sexton DJ, Kong L, Marr KA, Gopal AK, Gottlieb G, McClelland RS, Corey GR. Outcome of Staphylococcus aureus bacteremia according to compliance with recommendations of infectious diseases specialists: experience with 244 patients. Clin Infect Dis. 1998;27:478–86.PubMedCrossRefGoogle Scholar
  17. 17.
    Kim BN. Compliance with an infectious disease specialist’s advisory consultations on targeted antibiotic usage. J Infect Chemother. 2005;11:84–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Lo E, Rezai K, Evans AT, Madariaga MG, Phillips M, Brobbey W, Schwartz DN, Wang Y, Weinstein RA, Trenholme GM. Why don’t they listen? Adherence to recommendations of infectious disease consultations. Clin Infect Dis. 2004;38:1212–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Gómez J, Conde Cavero SJ, Hernández Cardona JL, Núñez ML, Ruiz Gómez J, Canteras M, Valdés M. The influence of the opinion of an infectious disease consultant on the appropriateness of antibiotic treatment in a general hospital. J Antimicrob Chemother. 1996;38:309–14.PubMedCrossRefGoogle Scholar
  20. 20.
    Méan M, Pavèse P, Tudela E, Dinh-Van KA, Mallaret MR, Stahl JP. Consultations with infectious disease specialists for patients in a teaching hospital: adherence in 174 cases. Presse Med. 2006;35:1461–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Pulcini C, Pradier C, Samat-Long C, Hyvernat H, Bernardin G, Ichai C, Dellamonica P, Roger PM. Factors associated with adherence to infectious diseases advice in two intensive care units. J Antimicrob Chemother. 2006;57:546–50.PubMedCrossRefGoogle Scholar
  22. 22.
    Sellier E, Pavese P, Gennai S, Stahl JP, Labarère J, François P. Factors and outcomes associated with physicians’ adherence to recommendations of infectious disease consultations for inpatients. J Antimicrob Chemother. 2010;65:156–62.PubMedCrossRefGoogle Scholar
  23. 23.
    Sellier E, Labarère J, Gennai S, Bal G, François P, Pavese P. Compliance with recommendations and clinical outcomes for formal and informal infectious disease specialist consultations. Eur J Clinical Microbiol Infect Dis. 2011;30:887–94.CrossRefGoogle Scholar
  24. 24.
    Gennai S, François P, Bal G, Epaulard O, Stahl JP, Vittoz JP, Pavese P. Evaluation of a remote infectious disease consultation. Med Mal Infect. 2009;39:798–805.PubMedCrossRefGoogle Scholar
  25. 25.
    Fraser GL, Stogsdill P, Dickens JD Jr, Wennberg DE, Smith RP Jr, Prato BS. Antibiotic optimization. An evaluation of patient safety and economic outcomes. Arch Intern Med. 1997;157:1689–94.PubMedCrossRefGoogle Scholar
  26. 26.
    Honda H, Krauss MJ, Jones JC, Olsen MA, Warren DK. The value of infectious diseases consultation in Staphylococcus aureus bacteremia. Am J Med. 2010;123:631–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Jenkins TC, Price CS, Sabel AL, Mehler PS, Burman WJ. Impact of routine infectious diseases service consultation on the evaluation, management, and outcomes of Staphylococcus aureus bacteremia. Clin Infect Dis. 2008;46:1000–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Byl B, Clevenbergh P, Jacobs F, Struelens MJ, Zech F, Kentos A, Thys JP. Impact of infectious diseases specialists and microbiological data on the appropriateness of antimicrobial therapy for bacteremia. Clin Infect Dis. 1999;29:60–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Evans RS, Pestotnik SL, Classen DC, Clemmer TP, Weaver LK, Orme JF Jr, Lloyd JF, Burke JP. A computer-assisted management program for antibiotics and other antiinfective agents. N Eng J Med. 1998;338:232–8.CrossRefGoogle Scholar
  30. 30.
    Taur Y, Smith MA. Adherence to the Infectious Diseases Society of America guidelines in the treatment of uncomplicated urinary tract infection. Clin Infect Dis. 2007;44:769–74.PubMedCrossRefGoogle Scholar
  31. 31.
    Girotti MJ, Fodoruk S, Irvine-Meek J, Rotstein OD. Antibiotic handbook and pre-printed perioperative order forms for surgical antibiotic prophylaxis: do they work? Can J Surg. 1990;33:385–8.PubMedGoogle Scholar
  32. 32.
    MacDougall C, Polk RE. Antimicrobial stewardship programs in health care systems. Clin Microbiol Rev. 2005;18:638–56.PubMedCrossRefGoogle Scholar
  33. 33.
    Mol PGM, Wieringa JE, NannanPanday PV, Gans ROB, Degener JE, Laseur M, Haaijer-Ruskamp FM. Improving compliance with hospital antibiotic guidelines: a time-series intervention analysis. J Antimicrob Chemother. 2005;55:550–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Linkin DR, Paris S, Fishman NO, Metlay JP, Lautenbach E. Inaccurate communications in telephone calls to an antimicrobial stewardship program. Infect Control Hosp Epidemiol. 2006;27:688–94.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • A. de La Blanchardière
    • 1
  • J. Boutemy
    • 1
  • P. Thibon
    • 2
  • J. Michon
    • 1
  • R. Verdon
    • 1
  • V. Cattoir
    • 3
  1. 1.Infectious Diseases UnitUniversity Hospital of CaenCaenFrance
  2. 2.Department of Hygiene and Public HealthUniversity Hospital of CaenCaenFrance
  3. 3.Department of MicrobiologyUniversity Hospital of CaenCaenFrance

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