[Elderly patients presenting with fever and respiratory problems in an intensive care unit. Diagnostic, therapeutic and prognostic impact of a systematic infectious disease consultation].
OBJECTIVE
To measure the impact of an infectious disease consultation on the morbidity and mortality in patients aged over 75 presenting with fever and respiratory signs and treated with antibiotics in an intensive care unit.


METHODS
Retrospective study comparing two groups of patients having been seen or not by an infectious disease specialist within the first 24 hours of hospitalisation. The data available before prescription of the antibiotherapy by the intensive care physician were collected, together with the diagnostic and therapeutic proposals of the infectious disease specialist. Morbidity and mortality were assessed from the medical files and nurses charts and included: duration of fever and hospitalisation, complications with antibiotherapy and venous catheters and the cause or causes of death.


RESULTS
169 patients were included, 115 of whom had been seen (study group) and 54 who had not bee seen (control group) by an infectious disease specialist. Sixty-six percent of the infectious disease specialists (76/115) proposed a differential diagnosis, although a diagnostic re-assessment was effective for only 22% of the patients in the control group (p< 0.01). A 50% reduction in antibiotic prescriptions was observed in the study group. The duration of hospitalisation was greater in the study group than in the control group (a mean of 10 versus 7 days, p<0.01), but was unrelated to the consultation with a specialist. The same result was observed with the complications of venous catheterism (16 versus 2 cases, p =0.04). The rate of mortality was of 13% in both groups.


CONCLUSIONS
The over-zealous diagnoses of infection are the primary cause of over-prescription of antibiotics. Despite the population studied, considered as fragile, the 50% reduction in antibiotics is without any negative prognostic impact.
Roger
P-M
PM
Service d'infectiologie, Centre hospitalier et universitaire, Nice. roger.pm@chu-nice.fr
Farhad
R
R
Pulcini
C
C
Mariette
A
A
Taurel
M
M
Oualid
H
H
Bertrand
F
F
Declémy
S
S
Dellamonica
P
P
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005334:Fever / Q000453:epidemiology*; D016330:Frail Elderly / Q000706:statistics & numerical data*; D005602:France; D006801:Humans; D007239:Infections / Q000453:epidemiology* / Q000628:therapy; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D011379:Prognosis; D012140:Respiratory Tract Diseases / Q000453:epidemiology*