[Consultations with infectious disease specialists for patients in a teaching hospital: Adherence in 174 cases].
OBJECTIVE
In a teaching hospital where infectious disease specialists were routinely consulted for infections in patients in other departments, we sought to assess adherence to the specialists' recommendations, identify the factors influencing adherence, and measure the proportion of nosocomial infections among these consultations.


METHODS
We collected data from intrahospital consultations with infectious disease specialists over a 4-week period. Afterwards (48 hours later), a physician and pharmacist collected all prescriptions for anti-infectious agents (dose, drug, combinations) and other orders (laboratory tests, radiology examination, isolation) for each patient.


RESULTS
There were 174 infectious disease consultations requested for 143 inpatients during the study period. Anti-infectious agents were prescribed for 52.4% of patients, modified for 22.4%, and stopped for 9.1%; 16.1% neither had nor required such treatment. The rate of adherence to the specialists' recommendations was 84.6% for anti-infectious prescriptions and 77.4% for other orders. The factors associated with adherence were a bedside consultation (p = 0.04) and a recommendation to stop rather than modify anti-infectious treatment (p = 0.02). Roughly 40% of the patients (n = 57) had a nosocomial infection, most often during hospitalization for surgery (53.1% versus 29.1%, p < 0.01). Consultations were requested for 20% of the nosocomial infections observed at Grenoble University Hospital (based on annual prevalence in 2005).


CONCLUSIONS
The specialist's presence at the patient's bedside has an impact on staff adherence to recommendations. These specialists play a vital role in managing nosocomial infections, which account for more than a third of these intrahospital' consultations.
Méan
Marie
M
Service des maladies infectieuses, Département de médecine aigüe et spécialisée.
Pavese
Patricia
P
Tudela
Emilie
E
Dinh-Van
Kim-Anh
KA
Mallaret
Marie-Reine
MR
Stahl
Jean-Paul
JP
D000293:Adolescent; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003141:Communicable Diseases; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005602:France; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008511:Medicine; D008875:Middle Aged; D012017:Referral and Consultation; D013038:Specialization
D000890:Anti-Infective Agents