title: Impact of infectious disease consultation on the clinical and economic outcomes of solid organ transplant recipients admitted for infectious complications.
abstract: BACKGROUND
  There has been a paucity of data on the healthcare resource utilization of infectious disease-related complications in solid organ transplant recipients. The aims of this study were to report the clinical and economic burden of infectious disease-related complications, along with the impact of infectious disease consultation.
  
  
  METHODS
  This cohort study evaluated patients requiring admission to a tertiary-care center during 2007, 2008, and 2011. Propensity score matching was used to estimate the effects of patient demographics, comorbidities, and transplant- and infection-related factors on 28-day hospital survival, length of stay (LOS), and medical costs.
  
  
  RESULTS
  Infectious disease-related complications occurred in 603 of 1414 (43%) admissions in 306 of 531 (58%) patients. Unadjusted 28-day mortality did not differ between those who received infectious disease consultations vs those who did not (2.9% vs 3.6%, P = .820), however, after propensity score matching, infectious disease consultation resulted in significantly greater 28-day survival estimates (hazard ratio = 0.33; log-rank P = .026), and reduced 30-day rehospitalization rates (16.9% vs 23.9%, P = .036). The median LOS and hospitalization costs were significantly increased for patients receiving an infectious disease consultation than in those managed by the attending team alone (7.0 vs 5.0 days, P = .002, and $9652 vs $6192, P = .003). However, the median LOS (5.5 vs 5.1 days, P = .31) and hospitalization costs ($8106 vs $6912, P = .63) did not differ significantly among those receiving an early infectious disease consultation (<48 hours) vs no consultation, respectively.
  
  
  CONCLUSIONS
  Infectious disease consultation in recipients of solid organ transplant is associated with increased LOS and hospitalization costs but decreased mortality and reduced rehospitalization rates. Early consultation with infectious disease specialists decreases healthcare resource utilization compared with delayed referrals.
authors.affiliation: Pharmaceutical Sciences, University of Toronto Pharmacy.
authors.forename: Bassem
authors.initials: B
authors.lastname: Hamandi
authors.affiliation: Transplant Infectious Diseases, University Health Network.
authors.forename: Shahid
authors.initials: S
authors.lastname: Husain
authors.affiliation: Transplant Infectious Diseases, University Health Network.
authors.forename: Atul
authors.initials: A
authors.lastname: Humar
authors.affiliation: Pharmaceutical Sciences, University of Toronto Eli Lilly Canada, Toronto, Ontario.
authors.forename: Emmanuel A
authors.initials: EA
authors.lastname: Papadimitropoulos
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003141:Communicable Diseases / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D017048:Health Care Costs; D006801:Humans; D016867:Immunocompromised Host; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D016019:Survival Analysis; D062606:Tertiary Care Centers; D066027:Transplant Recipients; D019737:Transplants; D016896:Treatment Outcome
keywords: costs; infectious disease; mortality; organ transplant; utilization