title: Formal adult infectious disease specialist consultations in the outpatient setting at a comprehensive cancer center (1998-2008): diverse and impactful.
abstract: OBJECTIVE
  The literature on the impact of infectious disease (ID) consulations in the outpatient treatment of cancer is scarce.
  
  
  METHODS
  The medical records of consecutive adult patients with cancer formally evaluated by two board-certified ID specialists in an outpatient setting at our institution over a 10-year period (1998-2008) were reviewed retrospectively. The patients' demographics, referring departments, purposes for consultation, ID specialist recommendations, and overall impact of consultations on outcome were analyzed.
  
  
  RESULTS
  We identified 598 patients who underwent ID specialist consultations. Most of them had solid tumors (53%), predominantly breast cancer, whereas non-Hodgkin's lymphoma was the most common hematologic malignancy. Almost half of the patients (45%) had active malignancies, but few of them were severely neutropenic (8%) or had been receiving high doses of corticosteroids (17%). The most frequent requests for consultation were culture or serologic test (15%), and treatment of cellulitis and/or surgical wound infections (14%). Of 337 isolated pathogens, the most prevalent were methicillin-resistant Staphylococcus aureus (13%) and Pseudomonas aeruginosa (8%), as well as atypical mycobacteria (16%) and Aspergillus species (11%). ID specialists provided alternative diagnoses in 53% of the cases, including identification of a different infection (46%), a noninfectious etiology (29%), colonization (16%), and drug-related toxic effects (9%). Overall, we deemed the contribution of the ID specialist to be significant in 62% of the consultations.
  
  
  CONCLUSIONS
  ID specialists contribute significantly to the outpatient care of individuals with cancer.
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas, Unit 1460, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
authors.forename: G
authors.initials: G
authors.lastname: Pongas
authors.forename: G
authors.initials: G
authors.lastname: Hamilos
authors.forename: K V
authors.initials: KV
authors.lastname: Rolston
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Kontoyiannis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000458:organization & administration; D002173:Cancer Care Facilities / Q000458:organization & administration; D003141:Communicable Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D055552:Infectious Disease Medicine / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000473:pathology; D024382:Professional Role; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D055815:Young Adult