Diagnosis and treatment of infectious diseases are getting more and more complicated. Everyday, new microorganisms are added to the list of agents infecting humankind. On the other hand, the menace of antibiotic resistance is at its peak and is steadily increasing. This situation has made antibiotic treatment an even very complex issue in the medical field, necessitating special training and experience. All specialties other than infectious diseases and subspecialty training programs may not fulfill these requirements. These complex situations bring infectious disease specialists (IDSs) forward. The IDSs are frequently expected to take part in the diagnosis, antibiotic therapy, and the infection control programs.
The research article by Erden et al,1 “The place and the efficacy of infectious disease consultations in the hospitals,” is published in the current issue of Infectious Diseases in Clinical Practice. Apparently, this study is the first of its kind to delineate the overall interrelations of IDSs with the other clinicians in the hospital.
In February 2003, the Turkish Ministry of Health issued a “Budget Enforcement Document” in which extended-spectrum parenteral antibiotics can be prescribed only by the IDSs. Any prescription irrelevant with this regulation, which mainly targeted financial objectives, has not been reimbursed by the state since then. This made Turkey a perfect place to evaluate the interrelations between the IDS and the referring clinicians.
In the article, the non-IDSs (NIDSs) were asked 2 questions. One was how to manage methicillin-resistant Staphylococcus aureus infections, and the second one was how to treat a staphylococcal infection, which was reported to be penicillin and oxacillin resistant. The first question was asked with the understanding that everyone related to antibiotic therapy should know the right answer. The second one assessed the interpretation and the extrapolation of laboratory data into clinical practice. Apparently, the results were awful. One fourth of the NIDSs in the first query and the half in the second one failed to give the valid answer. Moreover, most NIDSs perceived themselves as inadequate in using diagnostic tools for microbiology, that is, in the area of extremely complex issues in antimicrobial use, the place of IDS is extremely important for the whole hospital. However, on the other hand, another query arises. Do the IDSs provide satisfactory anti-infective assistance to the rest of the hospital? In that context, I was really impressed with the diversity of the questions ranging from the ethical issues to patient management or from the perceptions for quality of the service to system organization. I believe that the article stresses the place and importance of IDS consultation service particularly for the developing countries.
In the management of the patients with critical infection, 30% of the NIDSs (organ-based specialists) preferred to treat the patients by themselves. Both IDSs and NIDSs reported that the IDSs consult the patient rapidly; however, both sides accepted the presence of occasional delays. The authors recommended the use of mobile technologies to provide rapid contact between IDSs and NIDSs in that context. Another negative concern was that a small portion of the IDSs were reported to evaluate the patients only with the laboratory data or with the information the NIDSs provided. On the other hand, IDSs complained excessive consultation work from time to time. Even the patients with fever or leucocytosis were referred to IDSs from time to time without evaluation. One more point emphasized in the study was that the financial supports of drug companies have shifted toward the IDSs rather than NIDSs.
Anyway, mutual partnership seems to be established between IDSs and NIDSs in Turkey after 2003 regulations. I also believe that there may be reasonable consequences for the other countries, particularly for the developing ones, in the Turkish experience. Consequently, most of the NIDSs in Turkey believed that the supervision of the IDSs for anti-infective assistance was a rational strategy and contributed to the patients, to the infection control procedures, and to the economy. However, this procedure may need some improvements, which may well suit the health institution, for a better working consultation service.
1. Erden H, Kurtaran B, Arun O, et al.. The place and the efficacy of infectious diseases consultations in the hospitals. Infect Dis Clin Pract. 2012; 20: 128–133.