University Hospital, Grenoble, France.
J Antimicrob Chemother. 2010 Jan;65(1):156-62. doi: 10.1093/jac/dkp406.
Solicited consultations constitute a substantial workload for infectious disease specialists (IDSs). The impact of physician adherence to recommendations on clinical outcomes following solicited IDS consultations has not been previously studied. The objectives of the study were to identify the factors associated with adherence and to determine whether adherence to recommendations was associated with better clinical outcomes.
A prospective study was conducted on 621 patients, aged > or = 18 years, hospitalized in a university-affiliated hospital in France, who received an IDS consultation between December 2007 and June 2008. The main outcome was early clinical improvement, and the secondary outcomes were length of stay and in-hospital mortality.
Adherence to the IDS's recommendations was 88.2% (548/621) for antimicrobial treatment and 72.2% (317/439) for diagnostic or monitoring tests. In a multivariable analysis, independent factors of adherence to therapeutic recommendations were a community-acquired infection [adjusted odds ratio (OR), 1.8; 95% confidence interval (CI), 1.1-3.0] and discontinuation or non-use of antibiotic treatment (adjusted OR, 9.7; 95% CI, 1.2-80.3). Adherence to recommendations for antibiotic treatment was associated with a higher rate of early clinical improvement (60.7% versus 43.9%, P = 0.01), shorter median length of stay (20 days versus 23 days, P = 0.03) and comparable in-hospital mortality (7.7% versus 5.5%, P = 0.50).
Factors associated with non-adherence must be anticipated by IDSs during consultations, because non-adherence leads to worse clinical outcomes. Further studies are needed to identify the interventions that could improve physician adherence to recommendations made during solicited consultations.
邀请会诊构成传染病专家（IDS）的大量工作量。医师对征求的 IDS 会诊后临床结果的建议的坚持程度对临床结果的影响尚未进行过研究。本研究的目的是确定与坚持相关的因素，并确定对建议的坚持是否与更好的临床结果相关。
对 2007 年 12 月至 2008 年 6 月期间在法国一所大学附属医院住院的 621 名年龄≥18 岁的患者进行了前瞻性研究。主要结局是早期临床改善，次要结局是住院时间和院内死亡率。
抗菌治疗建议的坚持率为 88.2%（548/621），诊断或监测检验的建议坚持率为 72.2%（317/439）。在多变量分析中，坚持治疗建议的独立因素为社区获得性感染[校正优势比（OR），1.8；95%置信区间（CI），1.1-3.0]和抗生素治疗的停用或未使用（校正 OR，9.7；95%CI，1.2-80.3）。对抗生素治疗建议的坚持与更高的早期临床改善率相关（60.7%比 43.9%，P=0.01），中位住院时间更短（20 天比 23 天，P=0.03），院内死亡率相当（7.7%比 5.5%，P=0.50）。
IDS 在会诊期间必须预期不坚持的因素，因为不坚持会导致更差的临床结果。需要进一步研究以确定可改善对征求性会诊中提出的建议的坚持程度的干预措施。
