Outpatient Infectious Disease Research Articles

1841. Implementation of an Outpatient Antimicrobial Stewardship Program to Reduce Fluoroquinolone Overprescribing at a Veterans Affairs Medical Center (VAMC)

BackgroundFluoroquinolones are often overprescribed in outpatient settings; however, stewardship programs designed to prevent overuse are not well described. The primary purpose of this study was to evaluate the change in overall and appropriate fluoroquinolone prescribing rates by primary care providers within internal medicine primary care clinics at the Houston VAMC before and after implementation of an audit and feedback intervention.MethodsAll fluoroquinolone prescriptions written by internal medicine primary care providers were included in this study. A medical chart audit to assess the appropriateness of fluoroquinolone prescriptions was conducted, and face to face feedback was given to providers regarding prescribing patterns. Aggregate monthly fluoroquinolone utilization data were also provided. Monthly face to face academic detailing sessions were provided regarding the treatment of common outpatient infectious diseases, appropriate fluoroquinolone use, and suggested alternatives. Study objectives were assessed before and after the intervention time period using segmented regression time series analysis including non-intervention internal medicine primary care comparator clinics.ResultsIn the intervention clinics, rates of fluoroquinolone orders decreased from 9.4 ± 5.8 orders per week per 1,000 patient visits in the pre-intervention time period to 6.9 ± 6.6 orders per week per 1,000 patient visits in the post-intervention time periods. Using segmented regression analysis, controlling for change in prescribing rates in the non-intervention clinics, and changes in the rate of prescribing over time, the intervention was associated with a 3.1 ± 0.99 decrease in fluoroquinolone orders per week per 1,000 patient visits (P = 0.0019). The percentage of orders deemed appropriate increased from 50 ± 31% in the pre-intervention time period to 66 ± 53% in the post-intervention time period (P = 0.06). Rates of fluoroquinolone orders did not change in the non-intervention clinics.ConclusionAn audit and feedback intervention in ambulatory care clinics was able to reduce the rate of fluoroquinolone orders and increase the percent of orders deemed appropriate.Disclosures All authors: No reported disclosures.

Computer-based personalized feedback intervention for cigarette smoking and prescription analgesic misuse among persons living with HIV (PLWH)

Pain, tobacco cigarette smoking, and prescription opioid misuse are all highly prevalent among persons living with HIV (PLWH). Smoking and pain medication misuse can lead to deleterious outcomes, including more severe pain and physical impairment. However, we are not aware of any interventions that have attempted to address these issues in an integrated manner. Participants (N = 68) were recruited from an outpatient infectious disease clinic and randomized to either a computer-based personalized feedback intervention (Integrated PFI) that aimed to increase motivation, confidence, and intention to quit smoking, and decrease intentions to misuse prescription analgesic medications, or a Control PFI. Results indicated that PLWH who received the Integrated PFI (vs. Control PFI) evinced greater post-treatment knowledge of interrelations between pain and tobacco smoking. Moreover, participants who received the Integrated PFI and smoked at least 10 cigarettes per day (but not < 10 CPD) reported greater confidence and readiness/intention to quit smoking. Effects of the Integrated PFI on knowledge of pain and opioid misuse, and attitudes/intentions regarding prescription pain medication misuse were not statistically-significant. Taken together, these results indicate that this novel intervention strategy may offer promise for addressing a critical public health need in a population that is generally underrepresented in clinical research.

Infectious Diseases Specialty Intervention Is Associated With Better Outcomes Among Privately Insured Individuals Receiving Outpatient Parenteral Antimicrobial Therapy.

Outpatient parenteral antimicrobial therapy (OPAT) can be managed by specialists in infectious diseases (ID) or by other physicians. Better management of OPAT can reduce the likelihood of readmission or emergency department (ED) use. The relative success of ID specialists and other physicians in managing OPAT has received little study. We analyzed a national database of insurance claims for privately insured individuals under age 65, locating inpatient acute-care stays in 2013 and 2014 that were followed by OPAT. Through propensity scoring, patients who received outpatient ID intervention (ID-led OPAT) were matched 1-to-1 with those who did not (Other OPAT). We estimated regression models of hospital and ED admissions and of total healthcare payments over the first 30 days after discharge. The final analytic sample of 8200 observations was well balanced on clinical and demographic characteristics. Soft-tissue infection and osteomyelitis were the most common infections in the index event, each affecting more than 40% of individuals. Relative to those with Other OPAT, people with ID-led OPAT had lower odds of an ED admission (odds ratio [OR] 0.449, 95% confidence interval [CI] 0.311-0.645) or hospitalization (OR 0.661, 95% CI 0.557-0.791) over 30 days, and they accumulated $1488 less in total healthcare payments (95% CI -2 688.56--266.58). Among privately insured individuals below age 65, ID consultations during OPAT are associated with large and significant reductions in the rates of ED admission and hospital admission in the 30 days after index events, as well as lower total healthcare spending.

Increasing success and evolving barriers in the hepatitis C cascade of care during the direct acting antiviral era.

Barriers remain in the hepatitis C virus (HCV) cascade of care (CoC), limiting the overall impact of direct acting antivirals. This study examines movement between the stages of the HCV CoC and identifies reasons why patients and specific patient populations fail to advance through care in a real world population. We performed a single-center, ambispective cohort study of patients receiving care in an outpatient infectious diseases clinic between October 2015 and September 2016. Patients were followed from treatment referral through sustained virologic response. Univariate and multivariate analyses were performed to identify factors related to completion of each step of the CoC. Of 187 patients meeting inclusion criteria, 120 (64%) completed an evaluation for HCV treatment, 119 (64%) were prescribed treatment, 114 (61%) were approved for treatment, 113 (60%) initiated treatment, 107 (57%) completed treatment, and 100 (53%) achieved a sustained virologic response. In univariate and multivariate analyses, patients with Medicaid insurance were less likely to complete an evaluation and were less likely to be approved for treatment. Treatment completion and SVR rates are much improved from historical CoC reports. However, linkage to care following referral continues to be a formidable challenge for the HCV CoC in the DAA era. Ongoing efforts should focus on linkage to care to capitalize on DAA treatment advances and improving access for patients with Medicaid insurance.

The Impact of the Ryan White HIV/AIDS Medical Case Management Program on HIV Clinical Outcomes: A Longitudinal Study.

Medical case management (MCM) is a core medical service in The Ryan White HIV/AIDS Program and aims to provide treatment and care for people living with HIV/AIDS by engaging, identifying and eliminating barriers to HIV care. Little research has examined the impact of this intervention; therefore, the purpose of this study was to examine the how MCM affects HIV clinical outcomes. The study took place at a midwestern, outpatient infectious diseases clinic. This study utilized a longitudinal, retrospective study design to analyze to the impact of MCM engagement on HIV clinical outcomes (viral loads, CD4 counts) from 2009 to 2015 as a time-varying predictor. A total of 2773 patients were included in this study, of which 975 patients (35.2%) engaged in MCM. Among those in MCM, approximately 90% of the population were between 25 and 64years of age, more than three-quarters were African American men, mean time of HIV care engagement in at this clinic care was 3.2 (± 4.1), while mean years living with HIV was 10.5 (± 7.1). Throughout the study period, those engaged in MCM had a significantly faster improvement in their HIV clinical outcomes compared to the non-MCM group (p < 0.001). The study highlights the significant impact MCM services have on improving CD4 T cell counts and HIV viral loads. The successful care coordination that MCM offers clearly improves health outcomes while creating a network of patient care.

A cost-minimization analysis of dalbavancin compared to conventional therapy for the outpatient treatment of acute bacterial skin and skin-structure infections

ABSTRACTIntroduction: Acute bacterial skin and skin-structure infections (ABSSSI) are common infectious diseases (ID) that often require intravenous (IV) antibiotics. Dalbavancin is a novel lipoglycopeptide antibiotic administered once that is FDA-approved for the treatment of ABSSSI. No literature is available for real-world cost-comparability relative to conventional therapy.Methods: This retrospective chart review examined adults diagnosed with ABSSSI and treated with IV antibiotics at an outpatient ID clinic after hospital discharge from January 2015 to August 2016. Patients received either dalbavancin or conventional therapy. In-hospital baseline demographics as well as outpatient clinical variables and outcomes were assessed. The primary outcome was the total ID-related cost of care per patient. A Monte Carlo probalistic sensitivity analysis was conducted.Results: One hundred and fifty-eight patients were included: 64 received dalbavancin and 94 received conventional therapy. The total ID-related cost of care per patient was greater with dalbavancin (mean $4,561) vs conventional (mean $1,668), p < 0.01. In the subset of patients treated with daptomycin, the total ID-related cost (mean $5,218) was comparable to dalbavancin (mean $4,561).Conclusions: Dalbavancin was more costly than conventional therapy for the outpatient treatment of ABSSSI. This greater overall cost was likely driven by the higher acquisition cost of dalbavancin. Dalbavancin may be comparable to the daily use of daptomycin for ABSSSI.

Patient Self-Referral to Infectious Diseases Clinic: You Don’t Always Get What You Want, But Hopefully What You Need

BackgroundPatients call into the departments at the Cleveland Clinic Foundation (CCF) to request appointments directly for all specialties. The Infectious Diseases (ID) department chose to evaluate these self-referred patients being seen in our clinic due to (1) limited outpatient clinic appointment availability and (2) patients’ perception of need may not align with the subspecialty care provided.MethodsIn spring 2016, all self-referred patients requesting an outpatient ID evaluation were screened by the ID Access Plus program. Patients were called by administrative staff with a request for records from a licensed practitioner, and when received, were reviewed within 72 hours of receipt by a staff ID physician. Requests were either (1) accepted for appointment, (2) declined, or (3) referred to a more appropriate department within the CCF system. Patients who were declined appointments were informed by an administrator via telephone call. All patients were also informed of the ability for urgent referrals to be accepted with an MD to MD discussion.ResultsDuring a 12-month period a total of 1000 referrals were processed through the ID Access Plus program: 25% were declined for appointments; 45% were tabled as requested records were not received; and 30% had appointments scheduled. The most common patient reported reasons for self-referral to ID clinic were “Lyme disease” (10%) and “parasites” (4%). The “no-show” rate for scheduled self-referred patients was <5%. The median wait period for a new patient ID appointment in the department declined from over 40 days to < 10 days.ConclusionA system of prescreening patients self-referred to ID, requiring a review of medical records by ID clinicians, resulted in improved access for patients.Disclosures All authors: No reported disclosures.

"Tweak Your Order Set!" Implementation of Modified Laboratory Order Set Improves Hepatitis C Virus Screening Rates in People Living With Human Immunodeficiency Virus.

There are several barriers to annual hepatitis C virus antibody (HCVAb) testing, including lack of provider knowledge of the changing HCV epidemic and provider underestimation of a patient’s risk. We identified low rates of testing for HCVAb in people living with human immunodeficiency virus (HIV) in our outpatient HIV Infectious Diseases clinic, and we developed a quality improvement project to increase rates of HCVAb screening.

Impact of Insurance and Treatment Regimens on HCV Outcome: Long-term Follow-up Study

Background Directly acting agents (DAA) have revolutionized the treatment of Hepatitis C infection. However the access to appropriate drugs has been a barrier to therapy. Our objective of this study was to find the impact of insurance type and treatment regimen on outcome in patients with hepatitis C.Methods We have maintained a database of patients with HCV infection who were seen at our outpatient infectious disease clinic. We conducted a retrospective review of 160 patients who have been following since 2005–2006. In addition to baseline data, we also collected data on treatment status, regimens, outcome, insurance and reasons for no treatment. Statistical analyses included chi-square tests for categorical variables and ANOVA for numerical variables. This study was approved by the institutional review board.ResultsOf the 160 charts reviewed, we had complete records of 40 patients who had a median follow-up period of 12 years. Among them 75% of the patients had HCV genotype 1 (1a or 1b). Liver biopsy was available only for 50% patients which showed 32.5% had early stage (0–2) and 27.5% had late stage (3–4) fibrosis. Most of the patients (17) were treated with older therapies (peg-interferon alpha with or without boceprevir or telaprevir) and 7 with newer DAA combinations, whereas 16 patients did not receive treatment. All patients with private insurance received treatment whereas a large proportion with public aid did not (100% vs. 57%, P = 0.002). Total 19 of 28 treated patients achieved a sustained viral response beyond 2 years. All 7 patients who received newer DAAs were cured. Among the 16 patients who did not receive antiviral treatment, 5 (30%) had a poor outcome including liver cirrhosis (1), hepatocellular carcinoma (2 HCC), and death (2) compared with only 2 patients (1 cirrhosis, 1 HCC) in treated group (P <0.001). None of the patients in treated group died.Conclusion In this study, patients who did not have access to appropriate antiviral therapy had worse outcome. The main determinant for poor access to treatment was the type of insurance. It is important to improve access to treatment for all patients with HCV infection which can reduce the rate of progression to advanced liver disease and mortality.Disclosures All authors: No reported disclosures.

Value and Clinical Impact of an Infectious Disease-Supervised Outpatient Parenteral Antibiotic Therapy Program.

Background. Outpatient parenteral antibiotic therapy (OPAT) is a safe and effective modality for treating serious infections. This study was undertaken to define the value of OPAT in a multicentered infectious disease (ID) private practice setting. Methods. Over a period of 32 months, 6120 patients were treated using 19 outpatient ID offices in 6 states. Analysis included patient demographics, indications of OPAT, diagnoses, therapeutic agent, duration of therapy, and site of therapy initiation. Outcomes were stratified by therapeutic success, clinical relapse, therapeutic complications, and hospitalizations after initiating therapy. Statistical analysis included an ordinal logistic regression analysis. Results. Forty-three percent of patients initiated therapy in an outpatient office, and 57% began therapy in a hospital. Most common diagnoses treated were bone and joint (32.2%), abscesses (18.8%), cellulitis (18.5%), and urinary tract infection (10.8%). Ninety-four percent of patients were successfully treated, and only 3% were hospitalized after beginning therapy. Most common cause of treatment failure was a relapse of primary infection (60%), progression of primary infection (21%), and therapeutic complication (19%). Conclusions. An ID-supervised OPAT program is safe, efficient, and clinically effective. By maximizing the delivery of outpatient care, OPAT provides a tangible value to hospitals, payers, and patients. This program is a distinctive competency available to ID physicians who offer this service to patients.

Validation of Persian version of WHOQOL-HIV BREF questionnaire in Islamic Republic of Iran.

The aim of this cross-sectional study was to validate the first Persian version of the WHOQOL-HIV BREF questionnaire. The study sample comprised 61 patients regularly attending the outpatient infectious disease clinic consultation centre for patients with behavioural disorders in 2013-2014. The internal consistency, content related validity and reliability of WHOQOL-HIV BREF were evaluated. Content validity was quantified using the content validity ratio (CVR) according the to Lawshe formula. CVR > 0.51 and mean judgment > 2 were significant at P = 0.05. The Cronbach alpha score was > 0.7 for each domain and = 0.87 for the whole scale, indicating good reliability. Item-to-total correlation coefficient between each item and its respective domain was 0.39-0.87. The correlation between each domain and overall QOL was excellent. This study demonstrates that the Persian version of WHOQOL-HIV BREF is a valid and reliable tool for evaluation of QOL in HIV-infected patients.

Anorectal Lymphogranuloma Venereum in Madrid: A Persistent Emerging Problem in Men Who Have Sex With Men.

Since 2003, outbreaks of lymphogranuloma venereum (LGV) with anorectal syndrome have been increasingly recognized in many Western countries. All of them have been classified as LGV serovar L2b, mainly occurring in human immunodeficiency virus (HIV)-infected men who have had sex with men (MSM). We describe a series of 26 diagnosed cases of LGV proctitis in downtown Madrid, Spain, in 2014, after implementing routine diagnostic procedures for this disease in symptomatic MSM. We conducted an observational study of patients with symptomatic proctitis attending an outpatient infectious diseases clinic in Madrid, Spain during calendar year 2014. Clinical, epidemiological, laboratory, and therapeutic data were gathered and analyzed. Twenty-six patients were included in the analysis. All were MSM, and 24 of them were HIV-positive. All patients reported having acute proctitis symptoms including tenesmus (85%), pain (88%), constipation (62%), or anal discharge (96%). Proctoscopy showed mucopurulent exudate (25 patients [96%]), and rectal bleeding, with mucosal erythema and/or oedema in all cases. Rectal swabs were obtained from all patients, and LGV serovar L2 was confirmed in all of them. The cure rate was 100% after standard treatments with doxycycline 100 mg twice per day for 3 weeks. Simultaneous rectal infections with other sexually transmitted pathogens (gonorrhoea, herpes simplex virus, Mycoplasma genitalium) and systemic sexually transmitted diseases (STDs) (syphilis, acute HIV, and hepatitis C infections) were also documented in 12 patients (46%), but these co-infections did not appear to influence the clinical manifestations of LGV. Anorectal LGV is a common cause of acute proctitis and proctocolitis among HIV-infected MSM who practice unprotected anal sex, and it is frequently associated with other rectal STDs. The implementation of routine screening and prompt diagnosis of these rectal infections should be mandatory in all clinical settings attended by HIV and STD patients.

Synergy, Salary, and Satisfaction: Benefits of Training in Critical Care Medicine and Infectious Diseases Gleaned From a National Pilot Survey of Dually Trained Physicians.

An increasing number of physicians are seeking dual training in critical care medicine (CCM) and infectious diseases (ID). Understanding experiences and perceptions of CCM-ID physicians could inform career choices and programmatic innovation. All physicians trained and/or certified in both CCM and ID to date in the United States were sent a Web-based questionnaire in 2015. Responses enabled a cross-sectional analysis of physician demographics and training and practice characteristics and satisfaction. Of 202 CCM-ID physicians, 196 were alive and reachable. The response rate was 79%. Forty-six percent trained and 34% practice in the northeastern United States. Only 40% received dual training at the same institution. Eighty-three percent identified as either an intensivist with ID expertise (44%) or as equally an intensivist and ID physician (38%). Median salary was $265 000 (interquartile range [IQR], $215 000-$350 000). Practice settings were split between academic (45%) and community settings (42%). Two-thirds are clinicians but 62% conduct some research and 26% practice outpatient ID. Top reasons to dually specialize included clinical synergy (70%), procedural activity (50%), and less interest in pulmonology (49%). Although 38% cited less proficiency with bronchoscopy as a disadvantage, 87% seldom need pulmonary consultation in the intensive care unit. Median career satisfaction was 4 (IQR, 4-5) out of 5, and 76% would dually train again. CCM-ID graduates prefer the acute care setting, predominantly CCM or a combination of CCM and ID. They find combination training and practice to be synergistic and satisfying, but most have had to seek CCM and ID training independently at separate institutions. Given these findings, avenues for combined training in CCM-ID should be considered.

Integration of outpatient infectious diseases clinic pharmacy services and specialty pharmacy services for patients with HIV infection.

The integration of specialty pharmacy services and existing outpatient clinical pharmacy services within an infectious diseases (ID) clinic to optimize the care of patients with human immunodeficiency virus (HIV) infection is described. The management of HIV-infected patients is a highly specialized area of practice, often requiring use of complex medication regimens for reduction of HIV-associated morbidity and mortality prophylaxis and treatment of opportunistic infections, and prevention of HIV transmission. To maximize the effectiveness and safety of treatment with antiretroviral agents and associated pharmacotherapies, an interdisciplinary team is often involved in patient care. At Chicago-based Northwestern Medicine (NM), the outpatient ID clinic has long worked with an interdisciplinary care team including physicians, clinical pharmacists, nurses, and social workers to care for patients with HIV infection. In April 2014, specialty pharmacy services for patients with HIV infection were added to the NM ID clinic's care model to help maintain continuity of care and enhance patient follow-up. The care model includes well-defined roles for clinical pharmacists, pharmacy residents and students on rotation, and licensed pharmacy technicians. Specialty pharmacy services, including medication education, prescription fulfillment, assistance with medication access (e.g., navigation of financial assistance programs, completion of prior-authorization requests), and treatment monitoring, allow for closed-loop medication management of the HIV-infected patient population. Integration of specialty pharmacy services with the interdisciplinary care provided in the outpatient NM ID clinic has enhanced continuity of care for patients with HIV infection in terms of prescription filling, medication counseling, and adherence monitoring.

Neutropenia Associated with Long-Term Ceftaroline Use.

Ceftaroline is a fifth-generation cephalosporin with potent antimicrobial activity against Gram-positive and Gram-negative pathogens. Neutropenia is a rare serious adverse event for the class of cephalosporins; however, we observed several cases of severe neutropenia in our outpatient infectious disease practice believed to be associated with ceftaroline use. The aim of this study was to determine the incidence of neutropenia among patients receiving ceftaroline therapy for more than 7 days. We conducted a retrospective cohort analysis of patients admitted to an 800-bed regional medical center between June 2012 and December 2014 who received ceftaroline for more than 7 days to assess the incidence of developing clinically significant neutropenia. Demographic and patient care data points as well as underlying admitting and chronic diagnoses were retrospectively collected from the medical record. Clinically significant neutropenia was defined as an absolute neutrophil count (ANC) less than 1,500 cells/mm(3). Analysis was performed to determine the incidence, severity, and outcome of neutropenia following ceftaroline administration. A total of 39 patients were included in the cohort. The median duration of therapy was 27 days. Seven patients (18%) developed neutropenia while on ceftaroline therapy. Four (10%) of the neutropenic patients had an ANC of <500 cells/mm(3). The median first neutropenic day was day 17, with the median ANC nadir of 432 cells/mm(3) on day 24. We determined that extended ceftaroline infusion is associated with the development of neutropenia. We recommend obtaining a complete blood count (CBC) with differential at the onset of therapy and weekly thereafter. Should the ANC fall below 2,500 cells/mm(3), then twice-weekly CBCs should be monitored for the duration of ceftaroline therapy, and therapy should be discontinued if the ANC falls to 1,500 cells/mm(3) or less.

P16.28 Framingham coronary heart disease and cardiovascular risk assessments of hiv/aids malaysian population on haart: the importance of risks evaluations and predictions

Background Coronary heart disease (CHD) and cardiovascular diseases (CVDs) events have increasing trends mainly due to the multiple and complex mechanisms of chronic inflammation and anti-retroviral drugs adverse effects during HIV course. Due to the lack of information this study aimed to analyse the CHD and CVDs risk profiles, estimate the probability of events and evaluate the accuracy of the Framingham CHD equations comprehensively in HIV-infected Malaysian subjects on highly active antiretroviral therapy (HAART). Methods This is a cross-sectional study with a purposive sampling of 2046 HIV patients on HAART in an outpatient infectious disease clinic in Selangor Malaysia. Using digital medical records. all variables for Framingham equations including demographics, gender, fasting plasma glucose and lipid profiles, blood pressure, smoking and diabetes status, hypertension treatment, immunity indices and antiretroviral therapy were collected. 10-years CHD risks were predicted using Framingham Risk Score (FRS1998 and FRS 2002) models while CVDs risk by specific FRS (2008). Data analyses included descriptive statistics and binary logistic regression. Results CHD risks were estimated in 1920 (FRS 1998) and 2046 (FRS 2002) of HIV subjects while CVDs risk were evaluated in 1927 subjects. Median ages and percentage of male were 44 years and 81.4% (FRS 1998, 2002 and FRS 2008). Approximatly 90% were receiving NNRTI+ NRTI and just 13% and 10% were taking tenofovir and a protease inhibitor. Beside 11% were smokers while 14% as diabetic. Dyslipidemia was seen at least in 45% of population. Equally 8% had CD4 count Conclusions We found a high prevalence of dyslipidemia while the CHD risks measured by the Framingham scales 1998 and 2002 were low. Notably CVDs risk was high thus further investigations as well preventive management should be prioritised in this population.

Depressive Symptoms Mediate the Effect of HIV-Related Stigmatization on Medication Adherence Among HIV-Infected Men Who Have Sex with Men.

This study tested the hypothesis that depressive symptoms would mediate the association of HIV-related stigma to medication adherence. We recruited HIV-infected men who have sex with men (MSM; N=66; 66% White, 23% African-American) from an outpatient infectious disease clinic, and asked them to complete self-report measures. Mediational analyses showed that depressive symptoms fully mediated the association between HIV-related stigma and adherence. That is, stigma-related experiences were positively associated with depressive symptoms and negatively associated with adherence, and, in the final model, depressive symptoms remained a significant correlate of adherence while stigma did not. A test of the indirect effect of stigma on adherence through depressive symptoms was also significant (unstandardized b=-0.19; bootstrap 95% CI -0.45 to -0.01). These results highlight the importance of treating depressive symptoms in interventions aiming to improve medication adherence among HIV-infected MSM.

Factors influencing adherence to antibiotic therapy in patients with acute infections

Taking antibiotics in strict adherence to physician prescriptions is crucial for maintaining the stability of the drug concentration in the blood and for achieving the best therapeutic effects. The increasing antimicrobial resistance in recent decades has led the Ministry of Health and Welfare to promote the rational use of antibiotics and the use of a computer monitoring system to control the use of antibiotics in hospitals. Although non-adherence is considered as the major factor contributing to antimicrobial resistance, patient non-adherence to antibiotic prescriptions is an issue that has been largely overlooked. This paper explores this issue due to the serious threat from antimicrobial resistance and the few studies that have investigated patient adherence to antibiotic treatments for acute infections in Taiwan. The aims of the study include: (1) describe patient's adherence to antibiotic therapy for acute infections and (2) explore the potential factors of influence on antibiotic adherence such as demographics, disease characteristics, and knowledge of antibiotic treatment. The study used a descriptive correlational design. A convenience sample of 162 patients with acute infections was recruited from outpatient infectious disease clinics in Taoyuan City. Data were collected using the study questionnaire and analyzed using the chi-square test, Mann-Whitney U test, and logistic regression. The study results showed that only 40.1% of patients followed their prescription to take antibiotics completely. The remainder earned lower scores than their prescription-adhering counterparts for knowledge regarding the effects of antibiotics (U = 2654.5, p = .046). Results of logistic regression showed that knowledge regarding the effects of antibiotics was the most significant predictor (B = .481, p = .046) of adherence to antibiotic therapies. Non-adherence to prescriptions is prevalent in short-term antibiotic treatments prescribed for acute infections. This finding reminds healthcare providers to provide proper education to the recipients of antibiotic treatments, even those treated for a very short duration for acute infections in outpatient settings. Special attention should be pay to enhancing the understanding and appreciation of patients for the therapeutic effects of antibiotics.

Adult Infectious Disease Consultation over a 10-Year Period in a Community-Base Teaching Hospital

This is a descriptive review of a large number (5606) of both in and outpatient adult infectious disease consultation from a major teaching hospital over extended period (2001-2010). The purpose of the study is to get spectrum of ID and determine trends in occurrence by age and sex. The common inpatients ID consultations were SSTIs, septicemia, osteomyelitis and that for outpatient by far most common were HIV/AIDS in over a third, followed by SSTI, osteomyelitis. There was equal distribution by sex and race (African-American and Caucasian), but consultations increased with age (33% in 60 and 32% in 45-59 year) especially septicemia and osteomyelitis. This data base shows spectrum of ID consultations (in and outpatient) over a long period has significance to teaching, performance for future possibly prospective studies and research priorities.

Quality of life of men with AIDS and the model of social determinants of health.

OBJECTIVE: to analyze the quality of life (QoL) of men with AIDS from the perspective of the model of social determinants of health (MSDH). METHOD: cross-sectional study conducted in an outpatient infectious diseases clinic from a Brazilian university hospital over the course of one year with a sample of 138 patients. A form based on the MSDH was used to collect sociodemographic data addressing individual, proximal, intermediate determinants and the influence of social networks together with an instrument used to assess the QoL of people with HIV/AIDS. The project was approved by the Institutional Review Board (Protocol No. 040.06.12). RESULTS: according to MSDH, most men with AIDS were between 30 and 49 years old (68.1%), mixed race (59.4%), heterosexual (46.4%), single (64.5%), Catholic (68.8%), had a bachelor's degree (39.2%), had no children (61.6%), and had a formal job (71.0%). The perception of QoL in the physical, level of independence, environment, and spirituality domains was intermediate, while QoL was perceived to be superior in the domains of psychological and social relationship. A perception of lower QoL was presented by homosexual (p=0.037) and married men (p=0.077), and those with income below one times the minimum wage (p=0.042). A perception of greater QoL was presented by those without a religion (p=0.005), living with a partner (p=0.049), and those who had a formal job (p=0.045). CONCLUSION: social determinants influence the QoL of men with AIDS.