Infectious Diseases Consultation Effectively Reduces Antibiotic Use in Hospitals

Daily infectious diseases consultation was effective in reducing antibiotic use without affecting in-hospital mortality rates, according to study results published in BMC Infectious Diseases.

This 2-year retrospective study analyzed data from 1111 patients from a tertiary hospital in Milan, Italy to determine whether daily infectious diseases consultation was more effective than weekly consultation to reduce antibiotic use without worsening clinical outcomes.

Patients were placed in either a weekly (n=273) or daily consultation group (n=838) and were comparable in age, sex, and comorbidities. Approximately 40% of the patients were women, the median age was 73.5 years (interquartile range [IQR], 61-81 years), and the median age-adjusted Charlson comorbidity index was 6 (IQR, 4-8). More than half of the consultations were healthcare-associated infections.

Urinary tract infections and sepsis were more represented in the daily consultation group, and central nervous system infections and bone and joint infections were more common in the weekly consultation group.

Overall, 2552 infectious diseases consultations were performed. Of those, 18.4% of consultations were performed daily and 81.4% of consultations were performed weekly (mean consultation per patient, 2.3). Patients in the daily service group were seen earlier than the weekly service group (6 days vs 10 days; P <.001). Results showed that antibiotic therapy was started more often by a consultant with an infectious diseases specialist rather than the treating physician (11.6% vs 8%; P =.02).

After switching to daily service consultation, the number of infectious diseases consultation per 100 bed-days increased from 0.4 to 1.5 (P =.01) with the greatest increase observed in the emergency department (from 1.5 to 6.7; P <.001).

There was a significant decrease in total antibiotic consumption from 64 to 60 defined daily dose (DDD) per 100 bed-days, with the greatest decrease occurring in the emergency department (132 DDD/bed-days in weekly service vs 107 DDD/bed-days in daily service; P =.07). When the data was clustered by antibiotic classes, results showed a 33% reduction in glycopeptide use (P =.04), a 19% reduction in fluoroquinolone use (P <.001), and a non-significant reduction in carbapenem use (P =.3). The reduction in use of these 3 antibiotic classes was not accompanied by an increase use of other antibiotic classes.

Results showed no change in overall in-hospital mortality and a statistically insignificant increase in sepsis-related mortality (from 19.3% to 20.9%; P =.7).

Findings from this study further prove that infectious diseases consultation is “a valid tool for a successful large-scale [antimicrobial stewardship] programs,” the authors concluded.

Reference

Cona A, Gazzola L, Viganò O, Bini T, Marchetti GC, and Monforte A. Impact of daily versus weekly service of infectious diseases consultation on hospital antimicrobial consumption: a retrospective study. BMC Infect Dis. 2020;20(1):812. doi:10.1186/s12879-020-05550-1