title: Activity and impact on antibiotic use and costs of a dedicated infectious diseases consultant on a septic orthopaedic unit.
abstract: The Orthopaedic Service of the Geneva University Hospitals engages dedicated infectious disease (ID) specialists to assist in the treatment of infected patients. We investigated the daily clinical activity and the impact on antibiotic costs in the Septic Unit since 2000.
  
  
  METHODS
  Retrospective analysis of various databases. Prospective survey of clinical activity from January 2008 to March 2008.
  
  
  RESULTS
  According to the survey, the ID specialist performed 265 first-time and 1420 follow-up consultations (average of 11.4 consultations per working day). In 88% of cases the antibiotic regimen initiated by the surgeons was approved. When the ID specialist had to change antibiotic treatment, it was for de-escalation in 43.7%, discontinuance in 32.4%, and initiation in 24.4% of cases. From April 2007 to March 2008, the ID specialist decreased total antibiotic use by 43 DDD/100 patients-days (p=0.0006) in the Septic Unit. Direct antibiotic costs decreased by US$64,380 over the same period, equal to the annual salary of the ID specialist. There was no change in the number of recurrent infections.
  
  
  CONCLUSIONS
  The main antibiotic-related activity of the dedicated orthopaedic ID specialist in Geneva our institution was to discontinue or adjust a pre-existing antimicrobial therapy. This activity significantly reduced antibiotic use and related costs on a septic orthopaedic unit.
authors.affiliation: Orthopaedic Surgery Service, Geneva, Switzerland. ilker.uckay@hcuge.ch
authors.forename: Ilker
authors.initials: I
authors.lastname: Uçkay
authors.forename: Nathalie
authors.initials: N
authors.lastname: Vernaz-Hegi
authors.forename: Stephan
authors.initials: S
authors.lastname: Harbarth
authors.forename: Richard
authors.initials: R
authors.lastname: Stern
authors.forename: Laurence
authors.initials: L
authors.lastname: Legout
authors.forename: Laetitia
authors.initials: L
authors.lastname: Vauthey
authors.forename: Tristan
authors.initials: T
authors.lastname: Ferry
authors.forename: Anne
authors.initials: A
authors.lastname: Lübbeke
authors.forename: Mathieu
authors.initials: M
authors.lastname: Assal
authors.forename: Daniel
authors.initials: D
authors.lastname: Lew
authors.forename: Pierre
authors.initials: P
authors.lastname: Hoffmeyer
authors.forename: Louis
authors.initials: L
authors.lastname: Bernard
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000517:prevention & control; D003253:Consultants; D003365:Costs and Cost Analysis; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents