Wee Liang En, Tan Aidan Lyanzhiang, Wijaya Limin, Chlebicki Maciej Piotr, Thumboo Julian, Tan Ban Hock
Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore.
Department of Infectious Diseases, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
Trop Med Infect Dis. 2019 Nov 18;4(4):137. doi: 10.3390/tropicalmed4040137.
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.
传染病（ID）专家就复杂感染提供建议，并倡导实施抗生素管理计划（ASP）干预措施。研究表明，尽早转诊至ID专家处可改善患者预后；然而，并非所有转诊至ID专家处的情况都很及时。2016年1月至2018年1月，对一家新加坡三级医院所有转诊至ID专家处的病例进行了一项回顾性横断面研究。检查了以下质量指标：尽早转诊至ID专家处（入院后48小时内），以及即使在转诊至ID专家处后针对不适当抗生素使用的ASP干预措施。采用卡方检验进行单因素分析，采用逻辑回归进行多因素分析。对两年期间的6490例转诊病例进行了分析；其中，36.7%（2384/6490）来自外科科室，47.0%（3050/6490）来自内科科室，14.2%（922/6490）来自血液学/肿瘤学科室，2.1%（134/6490）转诊至移植ID服务处。血液学/肿瘤学患者和老年患者（年龄≥60岁）尽早转诊至ID专家处的几率较低，但尽管此前已转诊至ID专家处，随后针对不适当抗生素使用进行ASP干预的几率较高。老年患者和血液学/肿瘤学患者或许可以更早地转诊至ID专家处，并进一步优化其抗菌治疗方案，这或许可以通过促进ID专家与初级医生之间更密切的合作来实现。
