title: Infectious diseases consultations can make the difference: a brief review and a plea for more infectious diseases specialists in Germany.
abstract: Trained infectious diseases (ID) specialists are an integral part of inpatient and outpatient care in many countries, however, these specialized services are established only in selected tertiary care hospitals in Germany. This review summarises studies that addressed the impact of ID consultation services on patient care and outcome. Extensive data for a clinical benefit is available in the context of Staphylococcus aureus bacteremia (SAB), in which in-hospital or 30-day mortality was significantly reduced by 40-50 % in patients evaluated and treated in cooperation with ID consultants. This effect was associated with improved adherence to quality-of-care standards. Moreover, newer studies show a reduced length of hospital stay due to ID consultations, especially if patients are evaluated early in the course of their hospital stay. Of note, informal consultations do not seem to be equivalent to a formal ID consultation with bedside patient evaluation. Studies in other patient groups (solid organ transplant recipients or intensive care unit patients) or in the context of other infections (infective endocarditis, pneumonia, other bloodstream infections) also revealed positive effects of ID consultations. Higher rates of appropriate empirical and targeted antimicrobial treatments and de-escalation strategies due to successful pathogen identification were documented. These modifications resulted in lower treatment costs and decreased antimicrobial resistance development. Although there are methodological limitations in single studies, we consider the consistent and reproducible positive effects of ID consultations shown in studies in different countries and health care systems as convincing evidence for improved quality-of-care and treatment outcomes in patients with infectious diseases. Thus, we strongly recommend efforts to establish significantly more ID consultation services in hospitals in Germany.
authors.affiliation: Division of Infectious Diseases, Department of Medicine II, University Medical Center, Albert-Ludwigs-University Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany. siegbert.rieg@uniklinik-freiburg.de.
authors.forename: Siegbert
authors.initials: S
authors.lastname: Rieg
authors.affiliation: Division of Infectious Diseases, Department of Medicine II, University Medical Center, Albert-Ludwigs-University Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
authors.forename: Marc Fabian
authors.initials: MF
authors.lastname: Küpper
mesh_terms: D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D005858:Germany; D006801:Humans; D007902:Length of Stay; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013038:Specialization; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Bacteremia; Clinical Infectious diseases services; Infectious diseases consultation; Quality indicator; Quality-of-care; Staphylococcus aureus