Adherence to recommendations by infectious disease consultants and its influence on outcomes of intravenous antibiotic-treated hospitalized patients

作者：Farinas Maria Carmen^*; Saravia Gabriela; Calvo Montes Jorge; Benito Natividad; Martinez Garde Juan Jose; Farinas Alvarez Concepcion; Aguilar Lorenzo; Agueero Ramon; Amado Jose Antonio; Martinez Martinez Luis; Gomez Fleitas Manuel

来源：BMC Infectious Diseases, 2012, 12: 292.

DOI：10.1186/1471-2334-12-292

• Infectious diseases specialists
• Antibiotic intervention
• Antibiotic use
• Antibiotic management
• Antimicrobial stewardship

Background: Consultation to infectious diseases specialists (ID), although not always performed by treating physicians, is part of hospital%26apos;s daily practice. This study analyses adherence by treating physicians to written ID recommendations (inserted in clinical records) and its effect on outcome in hospitalized antibiotic-treated patients in a tertiary hospital in Spain. %26lt;br%26gt;Methods: A prospective, randomized, one-year study was performed. Patients receiving intravenous antimicrobial therapy prescribed by treating physicians for 3 days were identified and randomised to intervention (insertion of written ID recommendations in clinical records) or non-intervention. Appropriateness of empirical treatments (by treating physicians) was classified as adequate, inadequate or unnecessary. In the intervention group, adherence to recommendations was classified as complete, partial or non-adherence. %26lt;br%26gt;Results: A total of 1173 patients were included, 602 in the non-intervention and 571 in the intervention group [199 (34.9%) showing complete adherence, 141 (24.7%) partial adherence and 231 (40.5%) non-adherence to recommendations]. In the multivariate analysis for adherence (R-2 Cox=0.065, p=0.009), non-adherence was associated with prolonged antibiotic prophylaxis (p=0.004; OR=0.37, 95% CI=0.19-0.72). In the multivariate analysis for clinical failure (R-2 Cox=0.126, p%26lt;0.001), Charlson index (p%26lt;0.001; OR=1.19, 95% CI=1.10-1.28), malnutrition (p=0.006; OR= 2.00, 95% CI=1.22-3.26), nosocomial infection (p%26lt;0.001; OR=4.12, 95% CI=2.27-7.48) and length of hospitalization (p%26lt;0.001; OR=1.01, 95% CI=1.01-1.02) were positively associated with failure, while complete adherence (p=0.001; OR=0.35, 95% CI=0.19-0.64) and adequate initial treatment (p=0.010; OR=0.39, 95% CI=0.19-0.80) were negatively associated. %26lt;br%26gt;Conclusions: Adherence to ID recommendations by treating physicians was associated with favorable outcome, in turn associated with shortened length of hospitalization. This may have important health-economic benefits and stimulates further investigation.

• 出版日期2012-11-9