Méan Marie, Pavese Patricia, Tudela Emilie, Dinh-Van Kim-Anh, Mallaret Marie-Reine, Stahl Jean-Paul
Service des maladies infectieuses, Département de médecine aigüe et spécialisée.
Presse Med. 2006 Oct;35(10 Pt 1):1461-6. doi: 10.1016/s0755-4982(06)74835-7.
In a teaching hospital where infectious disease specialists were routinely consulted for infections in patients in other departments, we sought to assess adherence to the specialists' recommendations, identify the factors influencing adherence, and measure the proportion of nosocomial infections among these consultations.
We collected data from intrahospital consultations with infectious disease specialists over a 4-week period. Afterwards (48 hours later), a physician and pharmacist collected all prescriptions for anti-infectious agents (dose, drug, combinations) and other orders (laboratory tests, radiology examination, isolation) for each patient.
There were 174 infectious disease consultations requested for 143 inpatients during the study period. Anti-infectious agents were prescribed for 52.4% of patients, modified for 22.4%, and stopped for 9.1%; 16.1% neither had nor required such treatment. The rate of adherence to the specialists' recommendations was 84.6% for anti-infectious prescriptions and 77.4% for other orders. The factors associated with adherence were a bedside consultation (p = 0.04) and a recommendation to stop rather than modify anti-infectious treatment (p = 0.02). Roughly 40% of the patients (n = 57) had a nosocomial infection, most often during hospitalization for surgery (53.1% versus 29.1%, p < 0.01). Consultations were requested for 20% of the nosocomial infections observed at Grenoble University Hospital (based on annual prevalence in 2005).
The specialist's presence at the patient's bedside has an impact on staff adherence to recommendations. These specialists play a vital role in managing nosocomial infections, which account for more than a third of these intrahospital' consultations.
在一家教学医院中，其他科室的患者感染时会定期向传染病专家咨询，我们试图评估对专家建议的依从性，确定影响依从性的因素，并测量这些会诊中医院感染的比例。
我们收集了为期4周的医院内部与传染病专家会诊的数据。之后（48小时后），一名医生和药剂师收集了每位患者的所有抗感染药物处方（剂量、药物、联合用药）以及其他医嘱（实验室检查、放射学检查、隔离）。
在研究期间，为143名住院患者进行了174次传染病会诊。52.4%的患者开具了抗感染药物，22.4%的患者药物进行了调整，9.1%的患者停药；16.1%的患者既未使用也不需要此类治疗。抗感染处方对专家建议的依从率为84.6%，其他医嘱的依从率为77.4%。与依从性相关的因素包括床边会诊（p = 0.04）以及停止而非调整抗感染治疗的建议（p = 0.02）。大约40%的患者（n = 57）发生了医院感染，最常见于手术住院期间（53.1%对29.1%，p < 0.01）。在格勒诺布尔大学医院观察到的医院感染中，20%进行了会诊（基于2005年的年度患病率）。
专家在患者床边会对工作人员对建议的依从性产生影响。这些专家在医院感染管理中发挥着至关重要的作用，医院感染占这些医院内部会诊的三分之一以上。
