Adherence to recommendations by infectious disease consultants and its influence on outcomes of intravenous antibiotic-treated hospitalized patients
<p>Abstract</p> <p>Background</p> <p>Consultation to infectious diseases specialists (ID), although not always performed by treating physicians, is part of hospital’s daily practice. This study analyses adherence by treating physicians to written ID recommendations (ins...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2012-11-01
|
| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | http://www.biomedcentral.com/1471-2334/12/292 |
| _version_ | 1829496591854075904 |
|---|---|
| author | Fariñas María-Carmen Saravia Gabriela Calvo-Montes Jorge Benito Natividad Martínez-Garde Juan-José Fariñas-Alvarez Concepción Aguilar Lorenzo Agüero Ramón Amado José-Antonio Martínez-Martínez Luis Gómez-Fleitas Manuel |
| author_facet | Fariñas María-Carmen Saravia Gabriela Calvo-Montes Jorge Benito Natividad Martínez-Garde Juan-José Fariñas-Alvarez Concepción Aguilar Lorenzo Agüero Ramón Amado José-Antonio Martínez-Martínez Luis Gómez-Fleitas Manuel |
| author_sort | Fariñas María-Carmen |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Consultation to infectious diseases specialists (ID), although not always performed by treating physicians, is part of hospital’s daily practice. This study analyses adherence by treating physicians to written ID recommendations (inserted in clinical records) and its effect on outcome in hospitalized antibiotic-treated patients in a tertiary hospital in Spain.</p> <p>Methods</p> <p>A prospective, randomized, one-year study was performed. Patients receiving intravenous antimicrobial therapy prescribed by treating physicians for 3 days were identified and randomised to intervention (insertion of written ID recommendations in clinical records) or non-intervention. Appropriateness of empirical treatments (by treating physicians) was classified as adequate, inadequate or unnecessary. In the intervention group, adherence to recommendations was classified as complete, partial or non-adherence.</p> <p>Results</p> <p>A total of 1173 patients were included, 602 in the non-intervention and 571 in the intervention group [199 (34.9%) showing complete adherence, 141 (24.7%) partial adherence and 231 (40.5%) non-adherence to recommendations]. In the multivariate analysis for adherence (R<sup>2</sup> Cox=0.065, p=0.009), non-adherence was associated with prolonged antibiotic prophylaxis (p=0.004; OR=0.37, 95%CI=0.19-0.72). In the multivariate analysis for clinical failure (R<sup>2</sup> Cox=0.126, p<0.001), Charlson index (p<0.001; OR=1.19, 95%CI=1.10-1.28), malnutrition (p=0.006; OR=2.00, 95%CI=1.22-3.26), nosocomial infection (p<0.001; OR=4.12, 95%CI=2.27-7.48) and length of hospitalization (p<0.001; OR=1.01, 95%CI=1.01-1.02) were positively associated with failure, while complete adherence (p=0.001; OR=0.35, 95%CI=0.19-0.64) and adequate initial treatment (p=0.010; OR=0.39, 95%CI=0.19-0.80) were negatively associated.</p> <p>Conclusions</p> <p>Adherence to ID recommendations by treating physicians was associated with favorable outcome, in turn associated with shortened length of hospitalization. This may have important health–economic benefits and stimulates further investigation.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN83234896. <url>http://www.controlled-trials.com/isrctn/sample_documentation.asp</url></p> |
| first_indexed | 2024-12-16T07:34:44Z |
| format | Article |
| id | doaj.art-bdac81c5467a4088a17c685ddf5b7c12 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-16T07:34:44Z |
| publishDate | 2012-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-bdac81c5467a4088a17c685ddf5b7c122022-12-21T22:39:15ZengBMCBMC Infectious Diseases1471-23342012-11-0112129210.1186/1471-2334-12-292Adherence to recommendations by infectious disease consultants and its influence on outcomes of intravenous antibiotic-treated hospitalized patientsFariñas María-CarmenSaravia GabrielaCalvo-Montes JorgeBenito NatividadMartínez-Garde Juan-JoséFariñas-Alvarez ConcepciónAguilar LorenzoAgüero RamónAmado José-AntonioMartínez-Martínez LuisGómez-Fleitas Manuel<p>Abstract</p> <p>Background</p> <p>Consultation to infectious diseases specialists (ID), although not always performed by treating physicians, is part of hospital’s daily practice. This study analyses adherence by treating physicians to written ID recommendations (inserted in clinical records) and its effect on outcome in hospitalized antibiotic-treated patients in a tertiary hospital in Spain.</p> <p>Methods</p> <p>A prospective, randomized, one-year study was performed. Patients receiving intravenous antimicrobial therapy prescribed by treating physicians for 3 days were identified and randomised to intervention (insertion of written ID recommendations in clinical records) or non-intervention. Appropriateness of empirical treatments (by treating physicians) was classified as adequate, inadequate or unnecessary. In the intervention group, adherence to recommendations was classified as complete, partial or non-adherence.</p> <p>Results</p> <p>A total of 1173 patients were included, 602 in the non-intervention and 571 in the intervention group [199 (34.9%) showing complete adherence, 141 (24.7%) partial adherence and 231 (40.5%) non-adherence to recommendations]. In the multivariate analysis for adherence (R<sup>2</sup> Cox=0.065, p=0.009), non-adherence was associated with prolonged antibiotic prophylaxis (p=0.004; OR=0.37, 95%CI=0.19-0.72). In the multivariate analysis for clinical failure (R<sup>2</sup> Cox=0.126, p<0.001), Charlson index (p<0.001; OR=1.19, 95%CI=1.10-1.28), malnutrition (p=0.006; OR=2.00, 95%CI=1.22-3.26), nosocomial infection (p<0.001; OR=4.12, 95%CI=2.27-7.48) and length of hospitalization (p<0.001; OR=1.01, 95%CI=1.01-1.02) were positively associated with failure, while complete adherence (p=0.001; OR=0.35, 95%CI=0.19-0.64) and adequate initial treatment (p=0.010; OR=0.39, 95%CI=0.19-0.80) were negatively associated.</p> <p>Conclusions</p> <p>Adherence to ID recommendations by treating physicians was associated with favorable outcome, in turn associated with shortened length of hospitalization. This may have important health–economic benefits and stimulates further investigation.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN83234896. <url>http://www.controlled-trials.com/isrctn/sample_documentation.asp</url></p>http://www.biomedcentral.com/1471-2334/12/292Infectious diseases specialistsAntibiotic interventionAntibiotic useAntibiotic managementAntimicrobial stewardship |
| spellingShingle | Fariñas María-Carmen Saravia Gabriela Calvo-Montes Jorge Benito Natividad Martínez-Garde Juan-José Fariñas-Alvarez Concepción Aguilar Lorenzo Agüero Ramón Amado José-Antonio Martínez-Martínez Luis Gómez-Fleitas Manuel Adherence to recommendations by infectious disease consultants and its influence on outcomes of intravenous antibiotic-treated hospitalized patients BMC Infectious Diseases Infectious diseases specialists Antibiotic intervention Antibiotic use Antibiotic management Antimicrobial stewardship |
| title | Adherence to recommendations by infectious disease consultants and its influence on outcomes of intravenous antibiotic-treated hospitalized patients |
| title_full | Adherence to recommendations by infectious disease consultants and its influence on outcomes of intravenous antibiotic-treated hospitalized patients |
| title_fullStr | Adherence to recommendations by infectious disease consultants and its influence on outcomes of intravenous antibiotic-treated hospitalized patients |
| title_full_unstemmed | Adherence to recommendations by infectious disease consultants and its influence on outcomes of intravenous antibiotic-treated hospitalized patients |
| title_short | Adherence to recommendations by infectious disease consultants and its influence on outcomes of intravenous antibiotic-treated hospitalized patients |
| title_sort | adherence to recommendations by infectious disease consultants and its influence on outcomes of intravenous antibiotic treated hospitalized patients |
| topic | Infectious diseases specialists Antibiotic intervention Antibiotic use Antibiotic management Antimicrobial stewardship |
| url | http://www.biomedcentral.com/1471-2334/12/292 |
| work_keys_str_mv | AT farinasmariacarmen adherencetorecommendationsbyinfectiousdiseaseconsultantsanditsinfluenceonoutcomesofintravenousantibiotictreatedhospitalizedpatients AT saraviagabriela adherencetorecommendationsbyinfectiousdiseaseconsultantsanditsinfluenceonoutcomesofintravenousantibiotictreatedhospitalizedpatients AT calvomontesjorge adherencetorecommendationsbyinfectiousdiseaseconsultantsanditsinfluenceonoutcomesofintravenousantibiotictreatedhospitalizedpatients AT benitonatividad adherencetorecommendationsbyinfectiousdiseaseconsultantsanditsinfluenceonoutcomesofintravenousantibiotictreatedhospitalizedpatients AT martinezgardejuanjose adherencetorecommendationsbyinfectiousdiseaseconsultantsanditsinfluenceonoutcomesofintravenousantibiotictreatedhospitalizedpatients AT farinasalvarezconcepcion adherencetorecommendationsbyinfectiousdiseaseconsultantsanditsinfluenceonoutcomesofintravenousantibiotictreatedhospitalizedpatients AT aguilarlorenzo adherencetorecommendationsbyinfectiousdiseaseconsultantsanditsinfluenceonoutcomesofintravenousantibiotictreatedhospitalizedpatients AT agueroramon adherencetorecommendationsbyinfectiousdiseaseconsultantsanditsinfluenceonoutcomesofintravenousantibiotictreatedhospitalizedpatients AT amadojoseantonio adherencetorecommendationsbyinfectiousdiseaseconsultantsanditsinfluenceonoutcomesofintravenousantibiotictreatedhospitalizedpatients AT martinezmartinezluis adherencetorecommendationsbyinfectiousdiseaseconsultantsanditsinfluenceonoutcomesofintravenousantibiotictreatedhospitalizedpatients AT gomezfleitasmanuel adherencetorecommendationsbyinfectiousdiseaseconsultantsanditsinfluenceonoutcomesofintravenousantibiotictreatedhospitalizedpatients |