Timeliness of Infectious Diseases Referral and Inappropriate Antibiotic Usage Post-Referral in an Asian Tertiary Hospital

Abstract

Infectious diseases (ID) specialists advise on complicated infections and are advocates for the interventions of antibiotic stewardship programs (ASP). Early referral to ID specialists has been shown to improve patient outcomes; however, not all referrals to ID specialists are made in a timely fashion. A retrospective cross-sectional study of all referrals to ID specialists in a Singaporean tertiary hospital was conducted from January 2016 to January 2018. The following quality indicators were examined: early referral to ID specialists (within 48 h of admission) and ASP intervention for inappropriate antibiotic usage, even after referral to ID specialists. Chi-square was used for univariate analysis and logistic regression for multivariate analysis. A total of 6490 referrals over the 2-year period were analysed; of those, 36.7% (2384/6490) were from surgical disciplines, 47.0% (3050/6490) were from medical disciplines, 14.2% (922/6490) from haematology/oncology and 2.1% (134/6490) were made to the transplant ID service. Haematology/oncology patients and older patients (aged ≥ 60 years) had lower odds of early referral to ID specialists but higher odds of subsequent ASP intervention for inappropriate antibiotic usage, despite prior referral to an ID specialist. Elderly patients and haematology/oncology patients can be referred to ID specialists earlier and their antimicrobial regimens further optimised, perhaps by fostering closer cooperation between ID specialists and primary physicians.

Evaluation of Systemic Antifungal Use in a Latin American General Care Hospital: A Retrospective Study

“…It is important to consider that the majority of prescriptions considered appropriate in this study were made by infectious disease specialists, and none of the inappropriate prescriptions were made by these specialists. This highlights the significance of consulting infectious disease specialists in complex infections, as it has been observed that this is the most effective way to tailor antimicrobial therapy to the specific needs of each case without taking unnecessary risks [ 33 ]. Additionally, since a significant number of debatable and inappropriate prescriptions were related to antifungal dosing, this presents an opportunity to provide education to healthcare practitioners and further involve pharmacists in the multidisciplinary infectious disease team [ 10 ].…”