Factors associated with treatment failure after advice from infectious disease specialists - 05/12/19
, Y. Ruch a, N. Douiri a, P. Boyer b, X. Argemi a, Y. Hansmann a, N. Lefebvre aThis article has been published in an issue click here to access
Highlights |
• | The present study focuses on an interdisciplinary infectious disease subject. |
• | We assessed the impact of infectious disease advice given in our university hospital, mainly risk factors for treatment failure after infectious disease advice. |
• | We identified at-risk patient populations requiring particular attention from infectious disease specialists. |
• | The present study revealed that the Charlson comorbidity score at admission (OR=1.24, 95%CI [1.03–1.50]), a history of infection or colonization with multidrug-resistant bacteria (OR=8.27, 95%CI [1.37–49.80]), compliance with suggested treatment modifications (OR=0.09, 95%CI [0.01–0.67]), and deterioration of the patient's status on Day 3 after the infectious disease specialist's advice (OR=12.50, 95%CI [3.16–49.46]) were associated with treatment failure after infectious disease advice in the multivariate analysis. |
Abstract |
Objective |
Risk factors associated with treatment failure after the infectious disease specialist's (IDS) advice remain unknown. We aimed to identify these risk factors.
Methods |
We included patients hospitalized in our tertiary care center who consulted an infectious disease specialist between January 2013 and April 2015. Treatment failure was defined by a composite criterion: signs of sepsis beyond Day 3, ICU admission, or death. Treatment success was defined by the patient's sustained clinical improvement.
Results |
A total of 240 IDS recommendations were made. Diagnosis was changed for 64 patients (26.7%) and 50 patients experienced treatment failure after the IDS advice. In multivariate analysis, compliance with the IDS advice was associated with a higher rate of success (OR=0.09, 95%CI [0.01–0.67]). Variables associated with treatment failure in the multivariate analysis were Charlson comorbidity score at admission (OR=1.24, 95%CI [1.03–1.50]), a history of infection or colonization with multidrug-resistant bacteria (OR=8.27, 95%CI [1.37–49.80]), and deterioration of the patient's status three days after the IDS advice (OR=12.50, 95%CI [3.16–49.46]).
Conclusion |
Reassessing IDS recommendations could be interesting for specific patients to further adapt and improve them.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Antimicrobial stewardship, Anti-infective agents, Multidrug-resistant bacteria
Mappa
| ☆ | This work was presented in Saint Malo at the 18th National Congress of Infectious Diseases (JNI) – June 2017; Summary in Médecine et Maladies Infectieuses Volume 47, Issue 4, Supplement, Pages S35–S36. |
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