The impact of infectious disease specialists on antibiotic prescribing in hospitals

Abstract

Given the current bacterial resistance crisis, antimicrobial stewardship programmes are of the utmost importance. We present a narrative review of the impact of infectious disease specialists (IDSs) on the quality and quantity of antibiotic use in acute-care hospitals, and discuss the main factors that could limit the efficacy of IDS recommendations. A total of 31 studies were included in this review, with a wide range of infections, hospital settings, and types of antibiotic prescription. Seven of 31 studies were randomized controlled trials, before/after controlled studies, or before/after uncontrolled studies with interrupted time-series analysis. In almost all studies, IDS intervention was associated with a significant improvement in the appropriateness of antibiotic prescribing as compared with prescriptions without any IDS input, and with decreased antibiotic consumption. Variability in the antibiotic prescribing practices of IDSs, informal (curbside) consultations and the involvement of junior IDSs are among the factors that could have an impact on the efficacy of IDS recommendations and on compliance rates, and deserve further investigation. We also discuss possible drawbacks of IDSs in acute-care hospitals that are rarely reported in the published literature. Overall, IDSs are valuable to antimicrobial stewardship programmes in hospitals, but their impact depends on many human and organizational factors.

An antimicrobial stewardship program initiative: a qualitative study on prescribing practices among hospital doctors

“…In accordance with our findings, a Swedish study found that all categories of doctors perceived the ID-specialists as important for antimicrobial prescribing and –resistance [12], and may express what is described as egalitarian Scandinavian work systems with a corresponding low consumption of antimicrobials [10]. Since our interviewees are responsive to advice from ID-specialists and ID-specialists are found to improve appropriateness of antimicrobial prescribing, they should be included in multidisciplinary antimicrobial stewardship teams [32]. However, many Norwegian hospitals lack ID-specialists, as well as clinical pharmacists and microbiologists, i.e.…”

Antimicrobial stewardship in emergency departments: a neglected topic

“…A recent US qualitative study conducted in ED physicians showed that local knowledge sources, especially colleagues’ opinions, were perceived as more effective in modifying antibiotic prescribing behaviour than national guidelines 4. In the present study, an increased input of infectious disease specialists might have led to a significant decrease in total antibiotic use, in line with the literature 8. The authors nevertheless nicely demonstrated that changing antibiotic prescribing behaviour in EDs is possible, even without any restrictive measure.…”

Strategies and challenges of antimicrobial stewardship in long-term care facilities

“…Six studies involved some feedback to physicians and/or nurses [29,41,42,44,46,48], and five studies performed repeated interactions with physicians and/or nurses [29,42,44,46,48]. Jump et al described the positive impact of an Infectious Diseases (ID) on-site consultation service in a hospital-based American LTCF [2,44], in line with several studies demonstrating the value of ID specialists in acute-care hospitals [49]. This service met a previously unidentified need, providing resident-centred care through once-weekly rounds and asneeded communication through the electronic medical record and telephone consultations.…”