Infectious diseases consultations can make the difference: a brief review and a plea for more infectious diseases specialists in Germany

Abstract

Trained infectious diseases (ID) specialists are an integral part of inpatient and outpatient care in many countries, however, these specialized services are established only in selected tertiary care hospitals in Germany. This review summarises studies that addressed the impact of ID consultation services on patient care and outcome. Extensive data for a clinical benefit is available in the context of Staphylococcus aureus bacteremia (SAB), in which in-hospital or 30-day mortality was significantly reduced by 40–50 % in patients evaluated and treated in cooperation with ID consultants. This effect was associated with improved adherence to quality-of-care standards. Moreover, newer studies show a reduced length of hospital stay due to ID consultations, especially if patients are evaluated early in the course of their hospital stay. Of note, informal consultations do not seem to be equivalent to a formal ID consultation with bedside patient evaluation. Studies in other patient groups (solid organ transplant recipients or intensive care unit patients) or in the context of other infections (infective endocarditis, pneumonia, other bloodstream infections) also revealed positive effects of ID consultations. Higher rates of appropriate empirical and targeted antimicrobial treatments and de-escalation strategies due to successful pathogen identification were documented. These modifications resulted in lower treatment costs and decreased antimicrobial resistance development. Although there are methodological limitations in single studies, we consider the consistent and reproducible positive effects of ID consultations shown in studies in different countries and health care systems as convincing evidence for improved quality-of-care and treatment outcomes in patients with infectious diseases. Thus, we strongly recommend efforts to establish significantly more ID consultation services in hospitals in Germany.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. 1.

    Bursle EC, Playford EG, Looke DF. Infectious diseases consultations at an Australian tertiary hospital: a review of 11,511 inpatient consultations. Intern Med J. 2014;44:998–1004.

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Kern WV. Management of Staphylococcus aureus bacteremia and endocarditis: progresses and challenges. Curr Opin Infect Dis. 2010;23:346–58.

    Article  PubMed  Google Scholar 

  3. 3.

    Bai AD, Showler A, Burry L, Steinberg M, Ricciuto DR, Fernandes T, et al. Impact of Infectious Disease Consultation on Quality of Care, Mortality, and Length of Stay in Staphylococcus aureus Bacteremia: results From a Large Multicenter Cohort Study. Clin Infect Dis. 2015;60:1451–61.

    PubMed  Google Scholar 

  4. 4.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Lahey T, Shah R, Gittzus J, Schwartzman J, Kirkland K. Infectious diseases consultation lowers mortality from Staphylococcus aureus bacteremia. Medicine (Baltimore). 2009;88:263–7.

    Article  Google Scholar 

  6. 6.

    Lopez-Cortes LE, Del Toro MD, Galvez-Acebal J, Bereciartua-Bastarrica E, Farinas MC, Sanz-Franco M, et al. Impact of an evidence-based bundle intervention in the quality-of-care management and outcome of Staphylococcus aureus bacteremia. Clin Infect Dis. 2013;57:1225–33.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Nagao M, Iinuma Y, Saito T, Matsumura Y, Shirano M, Matsushima A, et al. Close cooperation between infectious disease physicians and attending physicians can result in better management and outcome for patients with Staphylococcus aureus bacteraemia. Clin Microbiol Infect. 2010;16:1783–8.

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Rieg S, Peyerl-Hoffmann G, de With K, Theilacker C, Wagner D, Hubner J, et al. Mortality of S. aureus bacteremia and infectious diseases specialist consultation—a study of 521 patients in Germany. J Infect. 2009;59:232–9.

    Article  PubMed  Google Scholar 

  9. 9.

    Robinson JO, Pozzi-Langhi S, Phillips M, Pearson JC, Christiansen KJ, Coombs GW, et al. Formal infectious diseases consultation is associated with decreased mortality in Staphylococcus aureus bacteraemia. Eur J Clin Microbiol Infect Dis. 2012;31:2421–8.

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Saunderson RB, Gouliouris T, Nickerson EK, Cartwright EJ, Kidney A, Aliyu SH, et al. Impact of routine bedside infectious disease consultation on clinical management and outcome of Staphylococcus aureus bacteraemia in adults. Clin Microbiol Infect. 2015;21:779–85.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Vogel M, Schmitz RP, Hagel S, Pletz MW, Gagelmann N, Scherag A, et al. Infectious disease consultation for Staphylococcus aureus bacteremia - A systematic review and meta-analysis. J Infect. 2016;72:19–28.

    Article  PubMed  Google Scholar 

  12. 12.

    Isobe M, Uejima E, Seki M, Yamagishi Y, Miyawaki K, Yabuno K, et al. Methicillin-resistant Staphylococcus aureus bacteremia at a university hospital in Japan. J Infect Chemother. 2012;18:841–7.

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Tissot F, Calandra T, Prod’hom G, Taffe P, Zanetti G, Greub G, et al. Mandatory infectious diseases consultation for MRSA bacteremia is associated with reduced mortality. J Infect. 2014;69:226–34.

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Holland TL, Arnold C, Fowler VG Jr. Clinical management of Staphylococcus aureus bacteremia: a review. JAMA. 2014;312:1330–41.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Forsblom E, Ruotsalainen E, Ollgren J, Jarvinen A. Telephone consultation cannot replace bedside infectious disease consultation in the management of Staphylococcus aureus Bacteremia. Clin Infect Dis. 2013;56:527–35.

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Kuo D, Gifford DR, Stein MD. Curbside consultation practices and attitudes among primary care physicians and medical subspecialists. JAMA. 1998;280:905–9.

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Pulcini C, Botelho-Nevers E, Dyar OJ, Harbarth S. The impact of infectious disease specialists on antibiotic prescribing in hospitals. Clin Microbiol Infect. 2014;20:963–72.

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Classen DC, Burke JP, Wenzel RP. Infectious diseases consultation: impact on outcomes for hospitalized patients and results of a preliminary study. Clin Infect Dis. 1997;24:468–70.

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Hamandi B, Husain S, Humar A, Papadimitropoulos EA. Impact of infectious disease consultation on the clinical and economic outcomes of solid organ transplant recipients admitted for infectious complications. Clin Infect Dis. 2014;59:1074–82.

    Article  PubMed  Google Scholar 

  20. 20.

    Schmitt S, McQuillen DP, Nahass R, Martinelli L, Rubin M, Schwebke K, et al. Infectious diseases specialty intervention is associated with decreased mortality and lower healthcare costs. Clin Infect Dis. 2014;58:22–8.

    Article  PubMed  Google Scholar 

  21. 21.

    Kunin CM, Tupasi T, Craig WA. Use of antibiotics. A brief exposition of the problem and some tentative solutions. Ann Intern Med. 1973;79:555–60.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Fox BC, Imrey PB, Voights MB, Norwood S. Infectious disease consultation and microbiologic surveillance for intensive care unit trauma patients: a pilot study. Clin Infect Dis. 2001;33:1981–9.

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Raineri E, Pan A, Mondello P, Acquarolo A, Candiani A, Crema L. Role of the infectious diseases specialist consultant on the appropriateness of antimicrobial therapy prescription in an intensive care unit. Am J Infect Control. 2008;36:283–90.

    Article  PubMed  Google Scholar 

  24. 24.

    Farinas MC, Saravia G, Calvo-Montes J, Benito N, Martinez-Garde JJ, Farinas-Alvarez C, et al. Adherence to recommendations by infectious disease consultants and its influence on outcomes of intravenous antibiotic-treated hospitalized patients. BMC Infect Dis. 2012;12:292.

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Yamamoto S, Hosokawa N, Sogi M, Inakaku M, Imoto K, Ohji G, et al. Impact of infectious diseases service consultation on diagnosis of infective endocarditis. Scand J Infect Dis. 2012;44:270–5.

    Article  PubMed  Google Scholar 

  26. 26.

    Lemmen SW, Hafner H, Kotterik S, Lutticken R, Topper R. Influence of an infectious disease service on antibiotic prescription behavior and selection of multiresistant pathogens. Infection. 2000;28:384–7.

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Lemmen SW, Becker G, Frank U, Daschner FD. Influence of an infectious disease consulting service on quality and costs of antibiotic prescriptions in a university hospital. Scand J Infect Dis. 2001;33:219–21.

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Gums JG, Yancey RW Jr, Hamilton CA, Kubilis PS. A randomized, prospective study measuring outcomes after antibiotic therapy intervention by a multidisciplinary consult team. Pharmacotherapy. 1999;19:1369–77.

    CAS  Article  PubMed  Google Scholar 

  29. 29.

    Retamar P, Portillo MM, Lopez-Prieto MD, Rodriguez-Lopez F, de Cueto M, Garcia MV, et al. Impact of inadequate empirical therapy on the mortality of patients with bloodstream infections: a propensity score-based analysis. Antimicrob Agents Chemother. 2012;56:472–8.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Marquet K, Liesenborgs A, Bergs J, Vleugels A, Claes N. Incidence and outcome of inappropriate in-hospital empiric antibiotics for severe infection: a systematic review and meta-analysis. Crit Care. 2015;19:63.

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Garnacho-Montero J, Gutierrez-Pizarraya A, Escoresca-Ortega A, Corcia-Palomo Y, Fernandez-Delgado E, Herrera-Melero I, et al. De-escalation of empirical therapy is associated with lower mortality in patients with severe sepsis and septic shock. Intensive Care Med. 2014;40:32–40.

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Leone M, Bechis C, Baumstarck K, Lefrant JY, Albanese J, Jaber S, et al. De-escalation versus continuation of empirical antimicrobial treatment in severe sepsis: a multicenter non-blinded randomized noninferiority trial. Intensive Care Med. 2014;40:1399–408.

    CAS  Article  PubMed  Google Scholar 

  33. 33.

    Singer C, Kaplan MH, Armstrong D. Bacteremia and fungemia complicating neoplastic disease. A study of 364 cases. Am J Med. 1977;62:731–42.

    CAS  Article  PubMed  Google Scholar 

  34. 34.

    Farmakiotis D, Kyvernitakis A, Tarrand JJ, Kontoyiannis DP. Early initiation of appropriate treatment is associated with increased survival in cancer patients with Candida glabrata fungaemia: a potential benefit from infectious disease consultation. Clin Microbiol Infect. 2015;21:79–86.

    Article  PubMed  Google Scholar 

  35. 35.

    Patel M, Kunz DF, Trivedi VM, Jones MG, Moser SA, Baddley JW. Initial management of candidemia at an academic medical center: evaluation of the IDSA guidelines. Diagn Microbiol Infect Dis. 2005;52:29–34.

    Article  PubMed  Google Scholar 

  36. 36.

    Takakura S, Fujihara N, Saito T, Kimoto T, Ito Y, Iinuma Y, et al. Improved clinical outcome of patients with Candida bloodstream infections through direct consultation by infectious diseases physicians in a Japanese university hospital. Infect Control Hosp Epidemiol. 2006;27:964–8.

    Article  PubMed  Google Scholar 

  37. 37.

    Sellier E, Labarere J, Gennai S, Bal G, Francois P, Pavese P. Compliance with recommendations and clinical outcomes for formal and informal infectious disease specialist consultations. Eur J Clin Microbiol Infect Dis. 2011;30:887–94.

    CAS  Article  PubMed  Google Scholar 

  38. 38.

    Vehreschild JJ, Morgen G, Cornely OA, Hartmann P, Koch S, Kalka-Moll W, et al. Evaluation of an infectious disease consultation programme in a German tertiary care hospital. Infection. 2013;41:1121–8.

    CAS  Article  PubMed  Google Scholar 

  39. 39.

    Pulcini C, Pradier C, Samat-Long C, Hyvernat H, Bernardin G, Ichai C, et al. Factors associated with adherence to infectious diseases advice in two intensive care units. J Antimicrob Chemother. 2006;57:546–50.

    CAS  Article  PubMed  Google Scholar 

  40. 40.

    de La BA, Boutemy J, Thibon P, Michon J, Verdon R, Cattoir V. Clinical benefit of infectious diseases consultation: a monocentric prospective cohort study. Infection. 2012;40:501–7.

    Article  Google Scholar 

  41. 41.

    Rieg S, Kupper MF. Impact of an infectious diseases consultation service on the quality of care and the survival of patients with infectious diseases. Z Evid Fortbild Qual Gesundhwes. 2015;109:500–10.

    Article  PubMed  Google Scholar 

  42. 42.

    Gomez J, Conde Cavero SJ, Hernandez Cardona JL, Nunez ML, Ruiz GJ, Canteras M, et al. 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.

    CAS  Article  PubMed  Google Scholar 

  43. 43.

    Byl B, Clevenbergh P, Jacobs F, Struelens MJ, Zech F, Kentos A, et al. Impact of infectious diseases specialists and microbiological data on the appropriateness of antimicrobial therapy for bacteremia. Clin Infect Dis. 1999;29:60–6.

    CAS  Article  PubMed  Google Scholar 

  44. 44.

    Fluckiger U, Zimmerli W, Sax H, Frei R, Widmer AF. Clinical impact of an infectious disease service on the management of bloodstream infection. Eur J Clin Microbiol Infect Dis. 2000;19:493–500.

    CAS  Article  PubMed  Google Scholar 

  45. 45.

    Eron LJ, Passos S. Early discharge of infected patients through appropriate antibiotic use. Arch Intern Med. 2001;161:61–5.

    CAS  Article  PubMed  Google Scholar 

  46. 46.

    Kerremans JJ, Verbrugh HA, Vos MC. Frequency of microbiologically correct antibiotic therapy increased by infectious disease consultations and microbiological results. J Clin Microbiol. 2012;50:2066–8.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  47. 47.

    Apisarnthanarak A, Danchaivijitr S, Bailey TC, Fraser VJ. Inappropriate antibiotic use in a tertiary care center in Thailand: an incidence study and review of experience in Thailand. Infect Control Hosp Epidemiol. 2006;27:416–20.

    Article  PubMed  Google Scholar 

  48. 48.

    Kawanami GH, Fortaleza CM. Factors predictive of inappropriateness in requests for parenteral antimicrobials for therapeutic purposes: a study in a small teaching hospital in Brazil. Scand J Infect Dis. 2011;43:528–35.

    Article  PubMed  Google Scholar 

  49. 49.

    Hosoglu S, Parlak Z, Geyik MF, Palanci Y. Critical evaluation of antimicrobial use–a Turkish university hospital example. J Infect Dev Ctries. 2013;7:873–9.

    Article  PubMed  Google Scholar 

  50. 50.

    Bornard L, Dellamonica J, Hyvernat H, Girard-Pipau F, Molinari N, Sotto A, et al. Impact of an assisted reassessment of antibiotic therapies on the quality of prescriptions in an intensive care unit. Med Mal Infect. 2011;41:480–5.

    CAS  Article  PubMed  Google Scholar 

  51. 51.

    Lesprit P, Landelle C, Girou E, Brun-Buisson C. Reassessment of intravenous antibiotic therapy using a reminder or direct counselling. J Antimicrob Chemother. 2010;65:789–95.

    CAS  Article  PubMed  Google Scholar 

  52. 52.

    Rimawi RH, Mazer MA, Siraj DS, Gooch M, Cook PP. Impact of regular collaboration between infectious diseases and critical care practitioners on antimicrobial utilization and patient outcome. Crit Care Med. 2013;41:2099–107.

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Siegbert Rieg.

Ethics declarations

Conflict of Interest

None of the authors declares any conflict of interests.

Additional information

A more detailed version of this manuscript was published in German in the journal ‘Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen’ (Der Einfluss eines infektiologischen Konsiliardienstes auf die Versorgungsqualität und das Überleben von Patienten mit Infektionskrankheiten) Volume 109, Issue 7, 2015, Pages 500–510 (doi: 10.1016/j.zefq.2015.09.008) [41].

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Rieg, S., Küpper, M.F. Infectious diseases consultations can make the difference: a brief review and a plea for more infectious diseases specialists in Germany. Infection 44, 159–166 (2016). https://doi.org/10.1007/s15010-016-0883-1

Download citation

Keywords

  • Infectious diseases consultation
  • Clinical Infectious diseases services
  • Quality-of-care
  • Staphylococcus aureus
  • Bacteremia
  • Quality indicator