title: Role of the infectious diseases specialist consultant on the appropriateness of antimicrobial therapy prescription in an intensive care unit.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Servizio di Terapie Intensive, Istituti Ospitalieri di Cremona, Cremona, Italy. rainerineto@libero.it.
authors.forename: Enrico
authors.initials: E
authors.lastname: Raineri
authors.forename: Angelo
authors.initials: A
authors.lastname: Pan
authors.forename: Placido
authors.initials: P
authors.lastname: Mondello
authors.forename: Annamaria
authors.initials: A
authors.lastname: Acquarolo
authors.forename: Andrea
authors.initials: A
authors.lastname: Candiani
authors.forename: Luciano
authors.initials: L
authors.lastname: Crema
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy; D005260:Female; D019983:Guideline Adherence; D020445:Hospitalists / Q000193:education; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards*; D016357:Infection Control Practitioners; D007318:Inservice Training; D007362:Intensive Care Units; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010347:Patient Care Planning; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012017:Referral and Consultation; D018571:Sentinel Surveillance
chemical_list: D000900:Anti-Bacterial Agents