, Volume 47, Issue 1, pp 27–33 | Cite as

Infectious disease services: a survey from four university hospitals in Germany

  • Siegbert RiegEmail author
  • Florian Hitzenbichler
  • Stefan Hagel
  • Isabelle Suarez
  • Florian Kron
  • Bernd Salzberger
  • Mathias Pletz
  • Winfried V. Kern
  • Gerd Fätkenheuer
  • Norma Jung
Original Paper



Involvement of infectious disease (ID) specialists in the care of hospitalized patients with infections through consultation services improves the quality of care and the outcome of patients. This survey aimed to describe activities and utilization of ID consultations at four German tertiary care hospitals.


A 1-month (March 2016) retrospective cross-sectional study at four university hospitals (Freiburg, Jena, Cologne and Regensburg) was performed. Only ID consultations with written documentation and bedside patient evaluation were included. Consultations were analyzed with regard to requesting departments, infections, case severity, and diagnostic and therapeutic recommendations.


In the study period, 638 ID consultations were performed in 479 patients—corresponding to 3–4 consultations per 100 inpatient cases. Patients were characterized by a high disease complexity—the mean case mix index in patients with consultation was 10.1 compared to 1.6 for all patients. ID consultations were requested by many different specialties, with approximately half of the requests coming from surgical disciplines. ID consultations resulted in revised diagnoses in 34% of the cases, provided recommendations for additional diagnostic procedures in 66%, and for modifications of antimicrobial regimens in 70% of the cases.


Infectious disease consultations were requested for patients with severe and complicated diseases and resulted in recommendations that highly impacted the diagnostic work-up and therapeutic management of patients. The results of this survey may help to estimate requirements for establishment of such services in Germany.


Infectious disease consultation Quality of care Quality indicators Patient management Difficult-to-treat infections Survival 




Compliance with ethical standards

Conflict of interest

None to declare.

Supplementary material

15010_2018_1191_MOESM1_ESM.docx (34 kb)
Supplementary material 1 (DOCX 34 KB)


  1. 1.
    Rieg S, Kupper MF. Infectious diseases consultations can make the difference: a brief review and a plea for more infectious diseases specialists in Germany. Infection. 2016;44:159–66.CrossRefGoogle Scholar
  2. 2.
    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.CrossRefGoogle Scholar
  3. 3.
    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.CrossRefGoogle Scholar
  4. 4.
    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.CrossRefGoogle Scholar
  5. 5.
    Goto M, Schweizer ML, Vaughan-Sarrazin MS, Perencevich EN, Livorsi DJ, Diekema DJ, et al. Association of evidence-based care processes with mortality in Staphylococcus aureus Bacteremia at Veterans Health Administration Hospitals, 2003–2014. JAMA Intern Med. 2017;177:1489–97.CrossRefGoogle Scholar
  6. 6.
    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.CrossRefGoogle Scholar
  7. 7.
    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.CrossRefGoogle Scholar
  8. 8.
    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.CrossRefGoogle Scholar
  9. 9.
    Sasikumar M, Boyer S, Remacle-Bonnet A, Ventelou B, Brouqui P. The value of specialist care-infectious disease specialist referrals-why and for whom? A retrospective cohort study in a French tertiary hospital. Eur J Clin Microbiol Infect Dis. 2017;36:625–33.CrossRefGoogle Scholar
  10. 10.
    Kern WV, Fatkenheuer G, Tacconelli E, Ullmann A. Infectious diseases as a clinical specialty in Germany and Europe. Z Evid Fortbild Qual Gesundhwes. 2015;109:493–9.CrossRefGoogle Scholar
  11. 11.
    Livorsi DJ, Heintz B, Jacob JT, Krein SL, Morgan DJ, Perencevich EN. Audit and feedback processes among antimicrobial stewardship programs: a survey of the society for healthcare epidemiology of America research network. Infect Control Hosp Epidemiol. 2016;37:704–6.CrossRefGoogle Scholar
  12. 12.
    Yinnon AM. Whither infectious diseases consultations? Analysis of 14,005 consultations from a 5-year period. Clin Infect Dis 2001;33:1661–7.CrossRefGoogle Scholar
  13. 13.
    Ingram PR, Cheng AC, Murray RJ, Blyth CC, Walls T, Fisher DA, et al. What do infectious diseases physicians do? A 2-week snapshot of inpatient consultative activities across Australia, New Zealand and Singapore. Clin Microbiol Infect. 2014;20:O737–44.CrossRefGoogle Scholar
  14. 14.
    Schlesinger Y, Paltiel O, Yinnon AM. Analysis and impact of infectious disease consultations in a general hospital. J Hosp Infect. 1998;40:39–46.CrossRefGoogle Scholar
  15. 15.
    Sexton DJ, Corey GR, Ingram CW, Morris VM, Haywood HB III. Consultation in university-based and community-based infectious disease practices: a prospective study. Clin Infect Dis. 1995;20:391–3.CrossRefGoogle Scholar
  16. 16.
    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.CrossRefGoogle Scholar
  17. 17.
    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.CrossRefGoogle Scholar
  18. 18.
    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.CrossRefGoogle 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.CrossRefGoogle Scholar
  20. 20.
    Chirillo F, Scotton P, Rocco F, Rigoli R, Borsatto F, Pedrocco A, et al. Impact of a multidisciplinary management strategy on the outcome of patients with native valve infective endocarditis. Am J Cardiol 2013;112:1171–6.CrossRefGoogle Scholar
  21. 21.
    Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Tleyjeh IM, Rybak MJ, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the american heart association. Circulation 2015;132:1435–86.CrossRefGoogle Scholar
  22. 22.
    Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del ZF, et al. 2015 ESC Guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015;36:3075–128.CrossRefGoogle Scholar
  23. 23.
    Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2013;56:e1–25.CrossRefGoogle Scholar
  24. 24.
    Berbari EF, Kanj SS, Kowalski TJ, Darouiche RO, Widmer AF, Schmitt SK, et al. 2015 infectious diseases society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin Infect Dis 2015;61:e26–46.CrossRefGoogle Scholar
  25. 25.
    Patterson TF, Thompson GR III, Denning DW, Fishman JA, Hadley S, Herbrecht R, et al. Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the infectious diseases society of America. Clin Infect Dis 2016;63:e1–60.CrossRefGoogle Scholar
  26. 26.
    Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the infectious diseases society of America. Clin Infect Dis 2016;62:e1–50.CrossRefGoogle Scholar
  27. 27.
    Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensiv Care Med. 2017;43:304–77.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Siegbert Rieg
    • 1
    Email author
  • Florian Hitzenbichler
    • 2
  • Stefan Hagel
    • 3
  • Isabelle Suarez
    • 4
    • 5
  • Florian Kron
    • 4
  • Bernd Salzberger
    • 2
  • Mathias Pletz
    • 3
  • Winfried V. Kern
    • 1
  • Gerd Fätkenheuer
    • 4
    • 5
  • Norma Jung
    • 4
  1. 1.Division of Infectious Diseases, Department of Medicine II, Medical Center - University of FreiburgFaculty of Medicine, University of FreiburgFreiburgGermany
  2. 2.Infectious Diseases UnitUniversity Hospital of RegensburgRegensburgGermany
  3. 3.Infectious DiseaseUniversity Hospital of JenaJenaGermany
  4. 4.Department I of Internal MedicineUniversity Hospital of CologneCologneGermany
  5. 5.German Center for Infection ResearchPartner Site Bonn-CologneCologneGermany

Personalised recommendations