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Open Access Research article

Adherence to recommendations by infectious disease consultants and its influence on outcomes of intravenous antibiotic-treated hospitalized patients

María-Carmen Fariñas1*, Gabriela Saravia1, Jorge Calvo-Montes2, Natividad Benito3, Juan-José Martínez-Garde4, Concepción Fariñas-Alvarez5, Lorenzo Aguilar6, Ramón Agüero7, José-Antonio Amado8, Luis Martínez-Martínez29 and Manuel Gómez-Fleitas10

Author affiliations

1 Infectious Diseases Unit, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008 Santander, Spain

2 Microbiology Department, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain

3 Infectious Diseases Unit, Hospital Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain

4 Pharmacy Department, Hospital Universitario Marques de Valdecilla, Av. Valdecilla s/n, 39008, Santander, Spain

5 Preventive Medicine Department, Hospital Sierrallana, Bª Ganzo s/n, 39300, Torrelavega, Cantabria, Spain

6 Microbiology Department, School of Medicine Universidad Complutense, Avda. Complutense s/n, 28040, Madrid, Spain

7 Pneumology Department, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain

8 Endocrinology Department, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain

9 Department of Molecular Biology, University of Cantabria, Avda. Cardenal Herrera Oria s/n, 39011, Santander, Spain

10 General Surgery Department, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain

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Citation and License

BMC Infectious Diseases 2012, 12:292  doi:10.1186/1471-2334-12-292

Published: 9 November 2012

Abstract

Background

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.

Methods

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.

Results

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 (R2 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 (R2 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.

Conclusions

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.

Trial registration

Current Controlled Trials ISRCTN83234896. http://www.controlled-trials.com/isrctn/sample_documentation.asp webcite

Keywords:
Infectious diseases specialists; Antibiotic intervention; Antibiotic use; Antibiotic management; Antimicrobial stewardship