Role of the infectious diseases specialist consultant on the appropriateness of antimicrobial therapy prescription in an intensive care unit
published online 31 January 2008.
Background
Use of routine microbiologic surveillance, antibiotic practice guidelines, and infectious diseases (ID) specialist consultation might contribute to achieve an early diagnosis and an appropriate antibiotic treatment of infections, particularly in an intensive care unit (ICU) setting.
Methods
We conducted a prospective cohort study in an ICU over a period of 4 years (2001-2004). We studied all patients with a possible or definite diagnosis of infection who received antimicrobial treatment, analyzing the appropriateness of antimicrobial therapy prescription before (P1) and after (P2) the implementation (January 1, 2003) of a systematic ID specialist consultation program.
Results
Among the 349 patients enrolled, we observed 205 infections during P1 and 197 during P2. Infections treated with appropriate antimicrobial therapy were 141 (68.8%) in P1 and 165 (83.7%) in P2 (P .0004). Compliance to the local guidelines for empirical antimicrobial therapy increased by 20.4% from P1 to P2 (P < .0001). Patients receiving an appropriate treatment had a significantly shorter duration of antibiotic treatment (P < .0001), mechanical ventilation (P < .0001), ICU stay (P < .0001), and reduced in-hospital mortality (P = .006). Adherence to local antibiotic therapy guidelines improved significantly from P1 (63.4%) to P2 (83.8%) (P < .0001).
Conclusion
The introduction of an ID specialist consultation program may improve the appropriateness of the antimicrobial therapy prescription in ICU and the adherence to the local antibiotic therapy guidelines. Furthermore, appropriate antibiotic therapy is associated with a reduction in both ICU and in-hospital mortality.
aServizio di Terapie Intensive, Istituti Ospitalieri di Cremona, Cremona, Italy
bIstituto di Anestesia e Rianimazione, Spedali Civili, Università di Brescia, Brescia, Italy
cDivisione di Malattie Infettive, Istituti Ospitalieri di Cremona, Cremona, Italy
Address correspondence to Enrico Raineri, MD, 2° Servizio di Anestesia e Rianimazione, Spedali Civili di Brescia, Piazzale Spedali Civili, 1, 25100 Brescia, Italy.
The study was conducted at the Istituti Ospitalieri di Cremona, a community hospital in Italy.
ABSTRACT