title: Impact of infectious diseases service consultation on diagnosis of infective endocarditis.
abstract: BACKGROUND
  The infectious diseases (ID) consultation service is a new clinical entity in Japan. We examined the impact of ID consultation on the diagnosis of infective endocarditis (IE) at a large teaching hospital in Japan.
  
  
  METHODS
  Routine consultation with an ID service for cases of positive blood culture was implemented at Kameda Medical Center in November 2004. In addition, ID service doctors started to give lectures on ID to doctors and also provided local guidelines on ID. We compared the incidence of IE during a 3-y and 10-month period before intervention with that during a 5-y and 2-month period after intervention. The modified Duke criteria were used to confirm the diagnosis of definite IE. Patients who fulfilled the criteria for definite IE were included in the analysis.
  
  
  RESULTS
  Twenty-seven cases of IE were diagnosed before the implementation of routine consultation, and 76 cases after. The respective incidences of IE were 48.7 and 84.8 per 100,000 patients discharged from the hospital (p = 0.01). The relapse rate of IE within 6 months was significantly lower in patients who underwent routine consultation (22.2% vs 2.2%; p = 0.02).
  
  
  CONCLUSIONS
  Routine consultation with an ID service for cases of positive blood culture, together with consecutive lecturing and local guidelines by ID specialists, resulted in improved detection of IE and a reduced relapse rate within 6 months. Timely consultation with an ID specialist in bacteraemia cases may be beneficial for improving the outcomes of patients in this setting.
authors.affiliation: Department of Infectious Diseases, Kyoto City Hospital, Kyoto City, Kyoto, Japan. shungo@sk9.so-net.ne.jp
authors.forename: Shungo
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Naoto
authors.initials: N
authors.lastname: Hosokawa
authors.forename: Misa
authors.initials: M
authors.lastname: Sogi
authors.forename: Mai
authors.initials: M
authors.lastname: Inakaku
authors.forename: Kazuya
authors.initials: K
authors.lastname: Imoto
authors.forename: Goh
authors.initials: G
authors.lastname: Ohji
authors.forename: Asako
authors.initials: A
authors.lastname: Doi
authors.forename: Sentaro
authors.initials: S
authors.lastname: Iwabuchi
authors.forename: Kentaro
authors.initials: K
authors.lastname: Iwata
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000175:diagnosis / Q000453:epidemiology; D003141:Communicable Diseases / Q000175:diagnosis* / Q000453:epidemiology; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D005260:Female; D006748:Hospital Departments; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies