Infectious Diseases Unit, University Hospital of Caen, Caen, France.
Infection. 2012 Oct;40(5):501-7. doi: 10.1007/s15010-012-0283-0. Epub 2012 Jun 22.
To determine the association of clinical outcomes with the adherence to Infectious Diseases Consultation (IDC) recommendations.
From March to August 2009, all patients hospitalized in our hospital, for whom an IDC was requested, were prospectively enrolled. The adherence to recommendations was ascertained after 72 h from the IDC. The primary objective of the study was to evaluate the clinical cure rate 1 month after the IDC, according to the adherence to IDC recommendations.
An IDC was requested for 258 inpatients. The infectious disease (ID) was most often non-severe (66%), community-acquired (62%), and already under treatment (47%). IDC proposals were most often formulated via a formal consultation (57%). Physicians' adherence to IDC recommendations was 87% for diagnostic tests and 90% for antibiotherapy. In the multivariate analysis, severe infections and direct consultation were independently associated with increased odds of adherence to recommendations for performing diagnostic tests (odds ratios 5.4 and 4.0, respectively). The overall clinical cure rate was 84% and this did not differ according to the adherence to IDC recommendations for diagnostic tests (84.3 vs. 71.4%, p = 0.15) and antimicrobial treatment (84.8 vs. 77.8%, p = 0.34).
Some limitations of the study may explain the lack of evidence of a clinical benefit, such as the very high level of adherence to IDC recommendations and the low proportion of severe infections. However, clinical improvement was always better when recommendations were followed. Therefore, further larger randomized multicentric studies including more patients suffering from more severe IDs may be needed in order to demonstrate a clinical impact.
确定临床结果与传染病咨询（IDC）建议的遵循情况之间的关联。
2009 年 3 月至 8 月，前瞻性地纳入我院所有因 IDC 而住院的患者。在 IDC 后 72 小时确定建议的遵守情况。该研究的主要目的是根据 IDC 建议评估 IDC 后 1 个月的临床治愈率。
为 258 名住院患者申请了 IDC。传染病（ID）通常不严重（66%），社区获得性（62%），并且已经在接受治疗（47%）。ID 咨询建议通常通过正式咨询（57%）提出。医生对 IDC 建议的遵守率为诊断性检查 87%，抗生素治疗 90%。在多变量分析中，严重感染和直接咨询与增加诊断测试建议遵守的可能性独立相关（比值比分别为 5.4 和 4.0）。总体临床治愈率为 84%，这与 IDC 建议的诊断性检查（84.3%比 71.4%，p=0.15）和抗菌治疗（84.8%比 77.8%，p=0.34）的遵守情况无关。
研究的一些局限性可能解释了缺乏临床获益的证据，例如 IDC 建议的遵守率非常高，以及严重感染的比例低。然而，当建议得到遵循时，临床改善总是更好。因此，可能需要进行更大规模的、随机的、多中心的研究，纳入更多患有更严重 ID 的患者，以证明临床影响。
