Influence of an infectious disease consulting service on quality and costs of antibiotic prescriptions in a university hospital.

Abstract

An infectious disease consulting service was set up at a large tertiary university hospital in 1996 to evaluate and to improve antibiotic prescription patterns. Treatment guidelines for the most common bacterial infections were implemented. On daily ward rounds antibiotic therapies without evidence of an infectious disease were stopped and inappropriate regimens were changed by an infectious disease specialist. During a 6-month prospective intervention period, 3,528 patients were studied on 13 wards of the department of internal medicine; 513 of these patients (14.5%) received antibiotic therapy. These treatment courses were evaluated as adequate in 394 cases (76.8%) and incorrect in 119 cases (23.2%). Inadequate antibiotic substances were chosen in 72 out of 119 cases (60.5%) and there was no indication for treatment in 38 out of 119 cases (32%). Pathogen-specific therapies were inadequate significantly more often than empirical antimicrobial therapies (p < 0.001). In addition, the duration of the perioperative prophylaxis could be limited to 1 d. Comparing the intervention period with a 3-month control interval without an infectious disease consulting service, a total of 31,510 Euro (including the costs for the infectious disease specialist) could be saved. No increase in infection-related mortality or length of stay was observed. These data show that an infectious disease consulting service optimizes antibiotic usage, and is cost-effective as a result of a significant cost reduction in hospitals, while not interfering with the quality of medical care.