title: The "Choosing Wisely" initiative in infectious diseases.
abstract: OBJECTIVE
  "Choosing Wisely" is a growing international campaign aiming at practice changes to improve patient health and safety by both, conduct of essential and avoidance of unnecessary diagnostic, preventive and therapeutic procedures. The goal is to create an easily recognizable and distributable list ("Choosing Wisely items") that addresses common over- and underuse in the management of infectious diseases.
  
  
  METHODS
  The German Society of Infectious Diseases (DGI) participates in the campaign "Klug Entscheiden" by the German Society of Internal Medicine. Committee members of the (DGI) listed potential 'Choosing Wisely items'. Topics were subjected to systematic evidence review and top ten items were selected for appropriateness. Five positive and negative recommendations were approved via individual member vote.
  
  
  RESULTS
  The final recommendations are: (1) Imperatively start antimicrobial treatment and remove the focus in Staphylococcus aureus bloodstream infection. (2) Critically ill patients with signs of infection need early appropriate antibiotic therapy. (3) Annual influenza vaccination should be given to individuals with age >60 years, patients with specific co-morbidities and to contact persons who may spread influenza to others. (4) All children should receive measles vaccine. (5) Prefer oral formulations of highly bioavailable antimicrobials whenever possible. (6) Avoid prescribing antibiotics for uncomplicated upper respiratory tract infections. (7) Do not treat asymptomatic bacteriuria with antibiotics. (8) Do not treat Candida detected in respiratory or gastrointestinal tract specimens. (9) Do not prolong prophylactic administration of antibiotics in patients after they have left the operating room. (10) Do not treat an elevated C-reactive protein (CRP) or procalcitonin with antibiotics for patients without signs of infection.
  
  
  CONCLUSIONS
  Physicians will reduce potential harm to patients and increase the value of health care when implementing these recommendations.
authors.affiliation: Department I of Internal Medicine, University of Cologne, Cologne, Germany. clara.lehmann@uni-koeln.de.|German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany. clara.lehmann@uni-koeln.de.
authors.forename: Clara
authors.identifier: http://orcid.org/0000-0002-7042-1578
authors.initials: C
authors.lastname: Lehmann
authors.affiliation: Department of Pediatrics, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Berner
authors.affiliation: Department of Infectious Diseases, Med Klinik IV, University Hospital Munich, Munich, Germany.
authors.forename: Johannes R
authors.initials: JR
authors.lastname: Bogner
authors.affiliation: Department I of Internal Medicine, University of Cologne, Cologne, Germany.|German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.|Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.
authors.forename: Oliver A
authors.initials: OA
authors.lastname: Cornely
authors.affiliation: Clinical Infectious Diseases and Antibiotic Stewardship Unit, Carl Carus University Hospital, Dresden, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: de With
authors.affiliation: Department of Internal Medicine II, University of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Herold
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Albert-Ludwigs-University Hospital and Medical Center, Freiburg, Germany.
authors.forename: Winfried V
authors.initials: WV
authors.lastname: Kern
authors.affiliation: Division of Infection Control and Infectious Diseases, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Lemmen
authors.affiliation: Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany.
authors.forename: Mathias W
authors.initials: MW
authors.lastname: Pletz
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Klinikum Sankt Georg, Leipzig, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Ruf
authors.affiliation: Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Salzberger
authors.affiliation: Infectiology Center Hamburg (ICH), Hamburg, Germany.
authors.forename: Hans Jürgen
authors.initials: HJ
authors.lastname: Stellbrink
authors.affiliation: Department of Internal Medicine/Infectious Diseases and Pulmonary Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Suttorp
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine II, Universitätsklinikum, Julius Maximilian's University, Würzburg, Germany.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Ullmann
authors.affiliation: Department I of Internal Medicine, University of Cologne, Cologne, Germany.|German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Fätkenheuer
authors.affiliation: Department I of Internal Medicine, University of Cologne, Cologne, Germany.
authors.forename: Norma
authors.initials: N
authors.lastname: Jung
mesh_terms: D003141:Communicable Diseases / Q000175:diagnosis* / Q000628:therapy*; D003695:Delivery of Health Care; D005858:Germany; D014943:Global Health; D006293:Health Promotion; D006801:Humans; D011634:Public Health; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*
keywords: Choosing Wisely; Infectious diseases; Recommendations