Rieg Siegbert, Küpper Marc Fabian
Division of Infectious Diseases, Department of Medicine II, University Medical Center, Albert-Ludwigs-University Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
Infection. 2016 Apr;44(2):159-66. doi: 10.1007/s15010-016-0883-1. Epub 2016 Feb 23.
Trained infectious diseases (ID) specialists are an integral part of inpatient and outpatient care in many countries, however, these specialized services are established only in selected tertiary care hospitals in Germany. This review summarises studies that addressed the impact of ID consultation services on patient care and outcome. Extensive data for a clinical benefit is available in the context of Staphylococcus aureus bacteremia (SAB), in which in-hospital or 30-day mortality was significantly reduced by 40-50 % in patients evaluated and treated in cooperation with ID consultants. This effect was associated with improved adherence to quality-of-care standards. Moreover, newer studies show a reduced length of hospital stay due to ID consultations, especially if patients are evaluated early in the course of their hospital stay. Of note, informal consultations do not seem to be equivalent to a formal ID consultation with bedside patient evaluation. Studies in other patient groups (solid organ transplant recipients or intensive care unit patients) or in the context of other infections (infective endocarditis, pneumonia, other bloodstream infections) also revealed positive effects of ID consultations. Higher rates of appropriate empirical and targeted antimicrobial treatments and de-escalation strategies due to successful pathogen identification were documented. These modifications resulted in lower treatment costs and decreased antimicrobial resistance development. Although there are methodological limitations in single studies, we consider the consistent and reproducible positive effects of ID consultations shown in studies in different countries and health care systems as convincing evidence for improved quality-of-care and treatment outcomes in patients with infectious diseases. Thus, we strongly recommend efforts to establish significantly more ID consultation services in hospitals in Germany.
在许多国家，训练有素的传染病（ID）专家是住院和门诊护理不可或缺的一部分，然而，在德国，这些专业服务仅在选定的三级护理医院中设立。本综述总结了探讨ID咨询服务对患者护理和结局影响的研究。在金黄色葡萄球菌菌血症（SAB）方面有大量关于临床获益的数据，在与ID顾问合作评估和治疗的患者中，住院或30天死亡率显著降低了40%-50%。这种效果与对护理质量标准的依从性提高有关。此外，最新研究表明，由于ID咨询，住院时间缩短，尤其是在患者住院早期进行评估时。值得注意的是，非正式咨询似乎不等同于床边患者评估的正式ID咨询。对其他患者群体（实体器官移植受者或重症监护病房患者）或其他感染（感染性心内膜炎、肺炎、其他血流感染）的研究也显示了ID咨询的积极效果。记录显示，由于成功鉴定病原体，经验性和针对性抗菌治疗以及降阶梯策略的适当率更高。这些改变导致治疗成本降低和抗菌药物耐药性发展减少。尽管单项研究存在方法学局限性，但我们认为在不同国家和医疗保健系统的研究中显示的ID咨询的一致且可重复的积极效果，是传染病患者护理质量和治疗结局改善的令人信服的证据。因此，我们强烈建议在德国的医院中大力建立更多的ID咨询服务。
