Background: To verify whether daily service of Infectious Diseases consultation (ID-cons) is more effective than weekly service in reducing antibiotic (ABT) consumption without worsening of clinical outcomes.
Methods: Two-years observational analysis of all the ID-cons provided in a hospital in Milan. ID-cons resulted in: start-of-ABT; no-ABT; confirmation; modification-of-ABT. We evaluated the impact of weekly (09/2016-09/2017) versus daily (10/2017-10/2018) service of ID-cons on: time-from-admission-to-first-ID-cons, type of ABT-intervention and number-of-ID-cons per 100patientdays(pd). Primary outcomes: (i) reduction of overall hospital ABT consumption and (ii) reduction of ABT consumption by department and by ABT classes expressed as defined-daily-dose (DDD)/100pd (by wilcoxon test for paired data). Secondary outcome: no significant increment of overall and sepsis-related in-hospital mortality (as death/patient’s admissions) from 2017 to 2018.
Results: Overall 2552 ID-cons in 1111 patients were performed (18.6% weekly vs 81.4% daily). No differences in patient’s characteristics were observed. In daily-service, compared to weekly, patients were seen by the ID-consultant earlier (time-from-admission-to-ID-cons: 6 days (IQR 2-13) vs 10 days (IQR 6-19), p<0.0001) and ABT was more often started by the ID-consultant (Start-of-ABT: 11.6% vs 8%, p=0.02). After switch to daily service, the number-of-ID-cons increased from 0.4/100pd to 1.5/100pd(p=0.01), with the greatest increase in the emergency department (1.5/100pd vs 6.7/100pd, p<0.0001). Total ABT consumption decreased from 62.1 to 59.3 DDD/100 pd, p=0.02. As for the number-of-cons, the consumption of ABT decreased mainly in the emergency area. According to ABT classes, glycopeptides’ consumption has been reduced from 3.1 to 2.1 DDD/100pd (p=0.02) while carbapenem use decreased from 3.7 to 3.1 DDD/100pd (p=0.07). No changes in overall-mortality (5.2% vs 5.2%) and sepsis-related mortality (19.3% vs 20.9%; p=0.7) were observed among the two time-period.
Conclusions: Daily-ID-cons resulted in a more comprehensive take charge of the infected patient by the ID-consultant especially in the emergency area where we also observed the highest rate of reduction of ABT-usage. No change in mortality was observed.