Others don´t, but Infectious Diseases Specialists (IDS) Must Bring Data: More Evidence to Support the Value of IDS
By Cèline Pulcini and José Ramón Paño
The management of infectious diseases in hospitals is becoming increasingly complex due to several reasons, some of which are:
- The relationship between hospital-managed infections and healthcare exposure, which is frequently associated with patients´ comorbidity (frailty) and it is linked to antimicrobial resistance.
- The growing burden of antimicrobial resistance in the setting of a dry antimicrobial pipeline, hampering the selection of active antimicrobials and on the the other hand, making essential an antimicrobial stewardship-based approach
- Ubiquity of infections in hospitals, as they can present in patients hospitalized in any ward or cared by any medical or surgical specialist.
Infectious Diseases specialists (IDS) in the hospital might act as primary providers of patients admitted in specific Infectious Diseases wards or as consultants providing support to “main” care-providers, usually for the management of the most difficult cases. Noteworthy, besides these patient care activities, IDS add value on transversal or horizontal non-patient care activities such as antimicrobial stewardship and other quality improvement activities, such as stated by McQuillen et al some years ago (see here).
It is plausible that given the complexity of the management of infectious diseases in hospitals, patients do benefit from the involvement of a IDS in their care. As plausible as it is in the case of acute coronary syndromes and cardiologists or Parkinson´s disease and neurologists, for instance. But this seems not be equally plausible for some in the case of Infectious Diseases. At least it is the case of Spain, France and Belgium, countries in which their respective governmental or regulatory institutions competent on medical specialties still do not officially recognize the specialty of Infectious Diseases, ignoring recommendations from the European Union of Medical Specialists (see here).
Even in countries in which the Infectious Diseases specialty is officially recognized, involvement of IDS in the management of patients with complex infectious diseases is variable, such as recently stated here (Ingram PR 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. Ahead of print. PMID 24494809).
“In other medical specialties they trust ; Infectious Diseases specialists must bring data”
These are some of the reasons why IDS, as opposed to other specialists, conduct research to evaluate their performance in the management of infectious diseases. Several original/review papers have been recently published on this topic and we would like to bring them to your attention:
- A Canadian prospective study showed that IDS consultation for hospitalized solid-organ transplant recipients was associated with reduced mortality at 28-days, along with decreased readmission rates (Hamandi B et al. Impact of Infectious Disease Consultation on the Clinical and Economic Outcomes of Solid-Organ Transplant Recipients Admitted for Infectious Complications. Clin Infect Dis. 2014. Ahead of Print. PMID 25009289).
- This adds to the findings previously published by Schmitt et al., who showed that IDS intervention in hospitals was associated with lower mortality and readmission rates in a large American study (Infectious diseases specialty intervention is associated with decreased mortality and lower healthcare costs. Clinical Infectious Diseases. 2014 Jan;58(1):22–8. PMID 24072931).
Interestingly, a recently published review deals with the performance of IDS when involved in activities aiming to improve antimicrobial use (Pulcini C, et al. The impact of infectious diseases specialists on antibiotic prescribing in hospitals. Clin Microbiol Infect. 2014. Ahead of Print. PMID doi: 10.1111/1469-0691.12751). This review confirms that IDS intervention was associated with a significant improvement of the appropriateness of antibiotic prescribing in hospitals compared with prescriptions without any IDS input, and with decreased antibiotic consumption.
The literature demonstrates that IDS are valuable to antimicrobial stewardship programmes in hospitals and their impact is likely to be greater when integrated in an antimicrobial stewardship team. Why don´t then listen to data?