Daily ID Consultations Linked With Reduction of Antimicrobial Consumption

As antimicrobial resistance is a serious public health threat, it is critical for clinicians to be more prudent in their prescribing habits.

In order to evaluate the role of infectious disease consultations in reducing antimicrobial consumption, a team of investigators from the infectious diseases unit at the University of Milan conducted an observational analysis.

The analysis sought to verify whether daily infectious disease consultations are more effective in reducing antimicrobial use without resulting in worsening of clinical outcomes when compared with weekly consultations.

The findings of the analysis were presented in a late-breaker poster session at the European Congress for Clinical Microbiology and Infectious Diseases (ECCMID 2019).

The study consisted of a 2-year observational analysis of infectious disease consultations at a hospital in Milan, Italy. The analysis evaluated the impact of weekly consultations performed between September 2016 and September 2017 when compared with daily consultations performed between October 2017 through October 2018.

The consultations resulted in the implementation of antimicrobials, the decision to not prescribe antimicrobials, confirmation of another physician’s decision to prescribe or not, and modification of the antimicrobial regimen.

For the study, the investigators focused on the time from the patient’s admission to the first infectious disease consultation, the type of antimicrobial intervention, and the number of infectious disease consultations per 100 patient days.

The primary outcome was the reduction of antimicrobial consumption expressed as defined-daily-dose per 100 patient days, including by Wilcoxon test for paired data. The investigators also looked at the secondary outcome of no significant increase of overall and sepsis-related in-hospital mortality from 2017 to 2018.

Throughout the 2-year study period, 2552 infectious disease consultations were conducted in 1111 patients; of this, 18.6% were conducted weekly and 81.4% were conducted daily. The investigators noted that no differences in patients’ characteristics were observed.

According to the results, patients who received daily infectious disease consultants were seen earlier, with the time from admission to ID consultation averaging 6 days (Interquartile range [IQR]: 2-3 days) compared with 10 days (IQR 6-19, p<0.0001) in the weekly consultations. Additionally, antimicrobials were more often started by the ID consultant (start-of-antimicrobials: 11.6% vs 8%, p = 0.02).

Following a switch to daily consultation, the investigators observed that the number of consultations increased from 0.4 per 100 patient days to 1.5 per 100 patient days (p = 0.01), with the greatest increase occurring in the emergency department (1.5 per 100 patient days vs 6.7 per 100 patient days, p<0.0001).

Furthermore, the overall antimicrobial consumption decreased from 62.1 to 59.3 defined-daily-dose per 100-person days (p = 0.02). In relation to the number of consultations, the consumption of antimicrobials decreased mainly in the emergency department (132 defined-daily-dose per 100-person days vs 107 defined-daily-dose per 100-person days).

Further details indicate that glycopeptide consumption was reduced from 3.1 to 2.1 defined-daily-dose per 100-person days (p = 0.02) while carbapenem use decreased from 3.7 to 3.1 defined-daily-dose per 100-person days (p = 0.07).

However, there were no changes observed in overall-mortality (5.2% vs 5.2%) and sepsis-related mortality (19.3% vs 20.9%; p = 0.7) during the study period.

“Daily infectious diseases consultations resulted in a more comprehensive take charge of the infected patient by the ID-consultant especially in the emergency area where we also observed the highest rate of reduction of [antimicrobial]-usage,” the investigators concluded.

The study, “Impact of daily versus weekly service of infectious diseases consultations on antimicrobial consumption,” was presented in an oral abstract presentation on April 13, 2019, at ECCMID 2019 in Amsterdam, the Netherlands.