Impact of infectious diseases consultation as a part of an antifungal stewardship programme on candidemia outcome in an Italian tertiary-care, University hospital

Abstract The role of the infectious disease specialist continues to evolve. The purpose of this study is to demonstrate the value of infectious disease consultation in the inpatient setting.METHODS This is a prospective cohort study that took place in a tertiary care university hospital. During the period from April to June 2016, 224 cases of patients receiving antibiotics in the hospital with the request of an infectious diseases’ consultation, were evaluated. The following variables were assessed: the referring department, purpose of the consultation, the antibiotic used before requesting the infectious diseases consultation, the antibiotic modifications after the infectious disease’s visit (changing the type, dose or range of the antibiotic when applicable, modifying the duration of antibiotic use), whenever the antibiotic usage was switched to a mono or bi-therapy.RESULTS The most frequent requesting departments were Oncology (23.2%) and Urology (21.4%). The purpose of the consultations was diagnosis (29%), therapy (41%), both diagnosis and therapy (21%), and prophylaxis (9%). An infectious diseases consultation was given at a rate of 4.9 consultations per 100 hospitalized patients. Antibiotic was discontinued in 14.7% of cases. There was no indication for the antibiotic treatment in 11.6% of cases. Modifying the antibiotic therapy was done in 25.4% of cases. Adjusting the antibiotic dosage was done in only one case. Carbapenem antibiotics were discontinued in 31.6% of cases and Quinolones discontinuation accounted for 22.7% of cases.CONCLUSION Infectious disease consults contributed to the optimization of the diagnostic and therapeutic approaches for suspected or confirmed infections in hospitalized patients.

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Impact of the inpatient infectious disease consultations at a tertiary care university hospital

The International Arabic Journal of Antimicrobial Agents ◽

10.3823/844 ◽

2020 ◽

Vol 10 (2) ◽

Author(s):

Rami Waked ◽

Danielle Jaafar ◽

Marie Chedid ◽

Gebrael Saliba ◽

Elie Haddad ◽

...

Keyword(s):

Infectious Disease ◽

Infectious Diseases ◽

Tertiary Care ◽

Hospitalized Patients ◽

University Hospital ◽

Inpatient Setting ◽

Therapeutic Approaches ◽

Infectious Diseases Consultation ◽

Disease Specialist

BACKGROUND: The role of the infectious disease specialist continues to evolve. The purpose of this study is to demonstrate the value of infectious disease consultation in the inpatient setting. METHODS: This is a prospective cohort study that took place in a tertiary care university hospital. During the period from April to June 2016, 224 cases of patients receiving antibiotics in the hospital with the request of an infectious diseases’ consultation, were evaluated. The following variables were assessed: the referring department, purpose of the consultation, the antibiotic used before requesting the infectious diseases consultation, the antibiotic modifications after the infectious disease’s visit, whenever the antibiotic usage was switched to a mono or bi-therapy. RESULTS: The most frequent requesting departments were Oncology (23.2%) and Urology (21.4%). The purpose of the consultations was diagnosis (29%), therapy (41%), both diagnosis and therapy (21%), and prophylaxis (9%). An infectious diseases consultation was given at a rate of 4.9 consultations per 100 hospitalized patients. Antibiotic was discontinued in 14.7% of cases. There was no indication for the antibiotic treatment in 11.6% of cases. Modifying the antibiotic therapy was done in 25.4% of cases. Adjusting the antibiotic dosage was done in only one case. Carbapenem antibiotics were discontinued in 31.6 % of cases and Quinolones discontinuation accounted for 22.7% of cases. CONCLUSION: Infectious disease consults contributed to the optimization of the diagnostic and therapeutic approaches for suspected or confirmed infections in hospitalized patients.

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Pharmacist-Driven Antibiotic Stewardship Program in Febrile Neutropenic Patients: A Single Site Prospective Study in Thailand

Antibiotics ◽

10.3390/antibiotics10040456 ◽

2021 ◽

Vol 10 (4) ◽

pp. 456

Author(s):

Kittiya Jantarathaneewat ◽

Anucha Apisarnthanarak ◽

Wasithep Limvorapitak ◽

David J. Weber ◽

Preecha Montakantikul

Keyword(s):

Infectious Diseases ◽

Antibiotic Stewardship ◽

Empirical Therapy ◽

University Hospital ◽

Control Group ◽

Great Opportunity ◽

Stewardship Program ◽

Determine Role ◽

Neutropenic Patients ◽

Infectious Diseases Consultation

The antibiotic stewardship program (ASP) is a necessary part of febrile neutropenia (FN) treatment. Pharmacist-driven ASP is one of the meaningful approaches to improve the appropriateness of antibiotic usage. Our study aimed to determine role of the pharmacist in ASPs for FN patients. We prospectively studied at Thammasat University Hospital between August 2019 and April 2020. Our primary outcome was to compare the appropriate use of target antibiotics between the pharmacist-driven ASP group and the control group. The results showed 90 FN events in 66 patients. The choice of an appropriate antibiotic was significantly higher in the pharmacist-driven ASP group than the control group (88.9% vs. 51.1%, p < 0.001). Furthermore, there was greater appropriateness of the dosage regimen chosen as empirical therapy in the pharmacist-driven ASP group than in the control group (97.8% vs. 88.7%, p = 0.049) and proper duration of target antibiotics in documentation therapy (91.1% vs. 75.6%, p = 0.039). The multivariate analysis showed a pharmacist-driven ASP and infectious diseases consultation had a favorable impact on 30-day infectious diseases-related mortality in chemotherapy-induced FN patients (OR 0.058, 95%CI:0.005–0.655, p = 0.021). Our study demonstrated that pharmacist-driven ASPs could be a great opportunity to improve antibiotic appropriateness in FN patients.

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A Statewide Assessment of Antifungal Stewardship Activities in Acute-Care Hospitals in Connecticut

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.609 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s105-s105

Author(s):

Romina Bromberg ◽

Vivian Leung ◽

Meghan Maloney ◽

Anu Paranandi ◽

David Banach

Keyword(s):

Infectious Diseases ◽

Acute Care ◽

Antifungal Therapy ◽

Antibiotic Stewardship ◽

Susceptibility Testing ◽

Antifungal Susceptibility ◽

Acute Care Hospitals ◽

Antifungal Susceptibility Testing ◽

Antifungal Stewardship ◽

Infectious Diseases Consultation

Background: Morbidity and mortality associated with invasive fungal infections and concerns of emerging antifungal resistance have highlighted the importance of optimizing antifungal therapy among hospitalized patients. Little is known about antifungal stewardship (AFS) practices among acute-care hospitals. We sought to assess AFS activities within Connecticut and to identify opportunities for improvement. Methods: An electronic survey assessing AFS practices was distributed to infectious disease physicians or pharmacy antibiotic stewardship program leaders in Connecticut hospitals. Survey questions evaluated AFS activities based on antibiotic stewardship principles, including several CDC Core Elements. Questions assessed antifungal restriction, prospective audit and feedback practices, antifungal utilization measurements, and the perceived utility of a local or statewide antifungal antibiogram. Results: Responses were received from 15 respondents, which represented 20 of 31 hospitals (65%); these hospitals made up the majority of the acute-care hospitals in Connecticut. Furthermore, 18 of these hospitals (58%) include antifungals in their stewardship programs. Also, 16 hospitals (52%) conduct routine review of antifungal ordering and provide feedback to providers for some antifungals, most commonly for amphotericin B, voriconazole, micafungin, isavuconazole, and flucytosine. All hospitals include guidance on intravenous (IV) to oral (PO) conversions, when appropriate. Only 14 of hospitals (45%) require practitioners to document indication(s) for systemic antifungal use. Most hospitals (17, 55%) provide recommendations for de-escalation of therapy in candidemia, though only 4 (13%) have institutional guidelines for candidemia treatment, and only 11 hospital mandates an infectious diseases consultation for candidemia. Assessing outcomes pertaining to antifungal utilization is uncommon; only 8 hospitals (26%) monitor days of therapy and 5 (16%) monitor antifungal expenditures. Antifungal susceptibility testing on Candida bloodstream isolates is performed routinely at 6 of the hospitals (19%). Most respondents (19, 95%) support developing an antibiogram for Candida bloodstream isolates at the statewide level. Conclusions: Although AFS interventions occur in Connecticut hospitals, there are opportunities for enhancement, such as providing institutional guidelines for candidemia treatment and mandating infectious diseases consultation for candidemia. The Connecticut Department of Public Health implemented statewide Candida bloodstream isolate surveillance in 2019, which includes antifungal susceptibility testing. The creation of a statewide antibiogram for Candida bloodstream infections is underway to support empiric antifungal therapy.Funding: NoneDisclosures: None

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Clinical and laboratory follow-up after hospitalization for COVID-19 at an Italian tertiary care center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab049 ◽

2021 ◽

Author(s):

Michele Spinicci ◽

Iacopo Vellere ◽

Lucia Graziani ◽

Marta Tilli ◽

Beatrice Borchi ◽

...

Keyword(s):

Infectious Diseases ◽

Care Center ◽

Tertiary Care ◽

University Hospital ◽

Tertiary Care Center ◽

Persistent Symptom ◽

Post Discharge

Abstract We evaluated 100 post-acute COVID-19 patients, a median of 60 days (IQR 48-67) after discharge from the Careggi University Hospital, Italy. Eighty-four (84%) had at least one persistent symptom, irrespective of COVID-19 severity. A considerable number of hospital re-admission (10%) and/or infectious diseases (14%) during the post-discharge period was reported.

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Importance of Infectious Diseases Consultation and the Use of Core Measures in the Management of Staphylococcus aureus Bacteremia (SAB) at a Tertiary Care Academic Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw172.787 ◽

2016 ◽

Vol 3 (suppl_1) ◽

Author(s):

Louis Crevecoeur ◽

Dong Heun Lee ◽

Nancy Law ◽

Tiffany Bias ◽

Sara Schultz

Keyword(s):

Staphylococcus Aureus ◽

Infectious Diseases ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Staphylococcus Aureus Bacteremia ◽

Academic Medical ◽

Infectious Diseases Consultation ◽

Core Measures

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Impact of Infectious Diseases Consultation on Mortality in Patients with Candidemia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx162.123 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S52-S52 ◽

Cited By ~ 2

Author(s):

Carlos Mejia ◽

Ryan Kronen ◽

Charlotte Lin ◽

Kevin Hsueh ◽

William Powderly ◽

...

Keyword(s):

Infectious Diseases ◽

Cox Regression ◽

Clinical Care ◽

Tertiary Care ◽

Central Line ◽

Care Hospital ◽

Consult Group ◽

Infectious Diseases Consultation ◽

To Receive ◽

Research Grant

Abstract Background An infectious diseases (ID) consultation is often, but not always, obtained to help guide treatment of patients with candidemia. We examined if ID consultation affected patient outcome in patients with culture positive candidemia. Methods We assembled a retrospective cohort of 1,873 cases of candidemia in patients hospitalized in our academic tertiary care hospital from 2002 to 2015. We collected data on comorbidities, predisposing factors; antifungal therapy, survival and ID consult. Patients who died within 24 hours of diagnosis were excluded, under the presumption that they did not have an opportunity to receive an ID consult. Survival analysis was performed via univariate and multivariate Cox Regression with censoring at 90 days, as subsequent mortality was less likely to be related to candidemia. Results 913 (49%) of the candidemic patients received an ID consult; 960 (51%) did not. Underlying comorbidities were evenly distributed between patients with and without an ID consult, except that patients with an ID consult more frequently had a central line (39% vs. 26%, p < 0.001), were on mechanical ventilation (4% vs. 2%, P = 0.003) or were receiving extracorporeal membrane oxygenation (2.2% vs. 0.5%, p = 0.002). The ID consult group had lower 90-day mortality compared with patients without an ID consult (34% vs. 49%, P < 0.001), with an adjusted hazard ratio of mortality for those patients receiving an ID consult of 0.55 (95% CI: 0.48, 0.64, P < 0.001) (Fig 1). Patient management differed significantly: the ID consult group was more likely to receive an echinocandin (29% vs. 21%, P < 0.001) or amphotericin B (AmB) (3.4% vs. 1.4%, P = 0.006). Conclusion Candidemic patients who received an ID consult were significantly less likely to die, and were more likely to receive therapy with amphotericin or an echinocandin. These data suggest that an ID consult should be an integral part of clinical care of patients with candidemia. Disclosures W. Powderly, Merck: Grant Investigator and Scientific Advisor, Consulting fee and Research grant; Gilead: Scientific Advisor, Consulting fee; Astellas: Grant Investigator, Research grant; A. Spec, Astellas Pharma US, Inc.: Grant Investigator, Research grant

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Improved mortality in Staphylococcus aureus bacteremia with the involvement of antimicrobial stewardship team and infectious disease consultation

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.136 ◽

2019 ◽

Vol 40 (8) ◽

pp. 932-935 ◽

Cited By ~ 3

Author(s):

Jacqueline E. Sherbuk ◽

Dayna McManus ◽

Jeffrey E. Topal ◽

Maricar Malinis

Keyword(s):

Infectious Disease ◽

Staphylococcus Aureus ◽

Retrospective Study ◽

Infectious Diseases ◽

Antimicrobial Stewardship ◽

Tertiary Care ◽

Staphylococcus Aureus Bacteremia ◽

Infectious Disease Consultation ◽

Academic Center ◽

Infectious Diseases Consultation

AbstractA retrospective study was conducted to evaluate the value of the antimicrobial stewardship team (AST) combined with infectious diseases consultation (IDC) on management and outcomes of Staphylococcus aureus bacteremia (SAB) in a tertiary-care academic center. Involvement of AST or IDC was associated with reduced mortality of SAB.

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