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Enfeksiyon hastalıkları ve klinik mikrobiyoloji kliniğinin konsültasyon iş yükü

Year 2020, Volume: 3 Issue: 3, 324 - 329, 18.06.2020
https://doi.org/10.32322/jhsm.738660

Abstract

Giriş: Hasta sayılarının artması, uygulanan invaziv girişimlerin çeşitliliği ve eşlik eden hastalıklardaki artış, hastaların yönetiminde multidisipliner yaklaşımı vazgeçilmez kılmaktadır. Özellikle immünsüpresyona yol açan tedavilerin çeşitlenmesi, yoğun bakım hasta sayıları ve yatış günlerinin artması, hastane enfeksiyonlarında artışa neden olmuş ve enfeksiyon hastalıkları uzmanlarına düşen sorumluk arttırmıştır. Çalışmamızda, bir üniversite hastanesinde, enfeksiyon hastalıkları uzmanlarının konsültasyon yükünü ortaya çıkarmayı ve disiplinler arası yaklaşımda, enfeksiyon hastalıkları uzmanlarının önemini vurgulamayı amaçladık.
Gereç ve Yöntem: Çalışmamız Ondokuz Mayıs Üniversitesi, Tıp Fakültesi Hastanesi’nde, enfeksiyon hastalıkları ve klinik mikrobiyoloji kliniğince yürütülmüş retrospektif bir çalışmadır. Ekim-Aralık 2018 tarihlerini kapsayan 3 aylık dönemde, enfeksiyon hastalıkları kliniğinden istenen tüm yazılı konsültasyonlar çalışmaya dahil edilmiştir.
Bulgular: Çalışma döneminde, hastanemizin tüm servislerinde 5916 tekil hasta yatışı yapılmıştır. Yatan hastaların 841 (%14,2)’inden 1433 kez enfeksiyon hastalıkları ve klinik mikrobiyoloji kliniğinden konsültasyon istenmiştir. Aynı dönemde erişkin yoğun bakım kliniğinde yatan 84 hasta ve hematoloji kliniğinde yatan 114 hasta tarafımızca takip edilmiş olup bu hastalar toplam 2319 kez görülmüştür. Acil servise başvuran 19781 hastadan 278 (%1,4)’i tarafımıza 373 kez danışılmış ve danışılan hastaların 20’si (%7,1) kliniğimize yatırılmıştır. Dahili kliniklerin, istatistiki olarak anlamlı derecede daha fazla konsültasyon istedikleri bulunmuştur.
Sonuç: Çalışma verilerimiz enfeksiyon hastalıkları uzmanlarının konsültasyon yükünü ortaya koymak ve multidisipliner yaklaşım içinde, enfeksiyon hastalıkları uzmanının değerini göstermek açısından önemlidir. Enfeksiyon hastalıkları uzmanları, hastanelerde yatan hastaların büyük bir kısmına, tedavi başlangıcından taburculuk kararına kadar katkı sağlamaktadırlar. Enfeksiyon hastalıkları uzmanlarının, hasta takibi, enfeksiyon kontrol önlemlerinin uygulanması, laboratuvar hizmetleri yanı sıra, ortaya koydukları konsültasyon hizmetlerinin değerinin, doktor meslektaşları, hastane yöneticileri, kanun koyucular ve düzenleyiciler tarafından tam olarak anlaşılmadığını düşünüyoruz.

References

  • 1. Özsüt H. İnfeksiyon hastalıkları konsültasyonları ve das işlemleri [Özet]. In: Murat G. Recep Ö. Sercan U. Meral G, eds. 5. Ulusal Sterilizasyon Dezenfeksiyon Kongresi Kitabı 2007 s:287-9.
  • 2. Petrak RM, Sexton DJ, Butera ML, et al. The value of an infectious diseases specialist. Clin Infect Dis 2003; 36: 1013 7.
  • 3. Jaffar A Al Tawfiq. The pattern and ımpact of ınfectious diseases consultation on antimicrobial prescription. J Global Infect Dis 2013; 5: 45.
  • 4. Byl B, Clevenbergh P, Jacobs F, et al. Impact of infectious diseases specialists and microbiological data on the appropriateness of antimicrobial therapy for bacteremia. Clin Infect Dis 1999; 29: 60-6.
  • 5. Granwehr BP, Kontoyiannis DP. The impact of infectious diseases consultation on oncology practice. Curr Opin Oncol 2013; 25: 353–9.
  • 6. Kollef MH. Inadequate antimicrobial treatment: An important determinant of outcome for hospitalized patients. Clin Infect Dis 2000; 31: S131 8.
  • 7. Russell MP, Robert M. Fliegelman DO, David WH. The art and science of ınfectious diseases consultation Infect Dis Clin Pract 2008; 16: 147-53.
  • 8. Aksoy SB, Coşkun Ö, Gül HC, Görenek L, Eyigün PC. Enfeksiyon hastalıkları konsültasyon hizmetlerinin antibiyotik kullanımı, direnç ve maliyet üzerindeki etkisi, Gülhane Tıp Derg. 2008; 50: 71-7.
  • 9. Resmî gazete [İnternet]. Bütçe uygulama talimatı [erişim 17 Temmuz 2019]. http://www.resmigazete.gov.tr/eskiler/2003/02/20030201.htm#7.
  • 10. Yinnon AM. Whither infectious diseases consultations? Analysis of 14005 consultations from a 5 year period. Clin Infect Dis 2001; 33: 1661-7.
  • 11. Nathwani D, Davey P, France AJ. Impact of an infection consultation service for bacteremia on clinical management and use of resources. Quart J Med 1996; 89: 789-97.
  • 12. Bruno P. Dimitrios P. The impact of infectious diseases consultation on oncology practice. Curr Opin Oncol 2013; 25: 353–9.
  • 13. Özsüt H, Eraksoy H, Dilmener M, Çalangu S, İnfeksiyon hastalıkları konsültasyonlarında karşılaşılan sorunlar ve çözüm yolları. Klimik Derg. 1994; 2: 101-2.
  • 14. Sharma R, Loomis W, Brown RB. Impact of mandatory inpatient infectious disease consultation on outpatient parenteral antibiotic therapy. Am J Med Sci 2005; 330: 60–4.
  • 15. Shrestha NK, Bhaskaran A, Scalera NM, et al. Antimicrobial stewardship at transition of care from hospital to community. Infect Control Hosp Epidemiol 2012; 33: 401–4.
  • 16. Singer C, Kaplan MH, Armstrong D. Bacteremia and fungemia complicating neoplastic disease. A study of 364 cases. Am J Med 1977; 62: 731–42.
  • 17. Honda H, Krauss MJ, Jones JC, et al. The value of infectious diseases consultation in Staphylococcus aureus bacteremia. Am J Med 2010; 123: 631–7.
  • 18. Patel M, Kunz DF, Trivedi VM, et al. Initial management of candidemia at an academic medical center: evaluation of the IDSA guidelines. Diagn Microbiol Infect Dis 2005; 52: 29–34.
  • 19. Takakura S, Fujihara N, Saito T, et al. Improved clinical outcome of patients with Candida bloodstream infections through direct consultation by infectious diseases physicians in a Japanese university hospital. Infect Control Hosp Epidemiol 2006; 27: 964–8.
  • 20. Forsblom E, Ruotsalainen E, Ollgren J, Jarvinen A. Telephone consultation cannot replace bedside infectious disease consultation in the management of Staphylococcus aureus bacteremia. Clin Infect Dis 2013; 56: 527–35.
  • 21. Pongas G, Hamilos G, Rolston KV, Kontoyiannis DP. Formal adult infectious disease specialist consultations in the outpatient setting at a comprehensive cancer center (1998–2008): diverse and impactful. Support Care Cancer 2012; 20: 261–5.

The workload of consultations in infectious diseases and clinical microbiology clinics

Year 2020, Volume: 3 Issue: 3, 324 - 329, 18.06.2020
https://doi.org/10.32322/jhsm.738660

Abstract

Introduction: The increase in the number of patients, invasive procedures, and concomitant diseases makes the multidisciplinary approach indispensable for the management of patients. In particular, the increase in the number of immunosuppressive and intensive care patients, as well as the prolonged hospitalization days, has led to an increase in hospital infections. Thus, increasing the responsibility of infectious disease specialists considerably. In this study, we aimed to reveal the consultation workload of infectious disease specialists as well as emphasize their importance in an interdisciplinary approach.
Material and Method: This is an retrospective study conducted at the infectious disease clinic of Ondokuz Mayıs University, Medical Faculty Hospital.
Results: During the study period, 5916 patients were hospitalized from which 841 (14.2%) inpatients were consulted 1433 times by the infectious disease service. In the same period, 84 patients hospitalized in an adult intensive care unit and 114 patients in the hematology clinic were seen 2319 times. Moreover, of the 19,781 patients admitted in the emergency department, 278 (1.4%) were consulted 373 times. Internal clinics were also found to require significantly more consultation than surgical clinics (p <0.05).
Conclusion: These data demonstrate the consultation workload of an infectious disease specialist and their value in a multidisciplinary approach. Infectious disease specialists contribute to the majority of hospitalized patients from the beginning of treatment to discharge decisions. However, their contribution is not fully comprehended by doctor colleagues, hospital managers, and legislators. This article will thus help infectious disease specialists demonstrate their consultation workload. In addition, new studies are needed for further measuring and defining the value of infectious disease specialists.

References

  • 1. Özsüt H. İnfeksiyon hastalıkları konsültasyonları ve das işlemleri [Özet]. In: Murat G. Recep Ö. Sercan U. Meral G, eds. 5. Ulusal Sterilizasyon Dezenfeksiyon Kongresi Kitabı 2007 s:287-9.
  • 2. Petrak RM, Sexton DJ, Butera ML, et al. The value of an infectious diseases specialist. Clin Infect Dis 2003; 36: 1013 7.
  • 3. Jaffar A Al Tawfiq. The pattern and ımpact of ınfectious diseases consultation on antimicrobial prescription. J Global Infect Dis 2013; 5: 45.
  • 4. Byl B, Clevenbergh P, Jacobs F, et al. Impact of infectious diseases specialists and microbiological data on the appropriateness of antimicrobial therapy for bacteremia. Clin Infect Dis 1999; 29: 60-6.
  • 5. Granwehr BP, Kontoyiannis DP. The impact of infectious diseases consultation on oncology practice. Curr Opin Oncol 2013; 25: 353–9.
  • 6. Kollef MH. Inadequate antimicrobial treatment: An important determinant of outcome for hospitalized patients. Clin Infect Dis 2000; 31: S131 8.
  • 7. Russell MP, Robert M. Fliegelman DO, David WH. The art and science of ınfectious diseases consultation Infect Dis Clin Pract 2008; 16: 147-53.
  • 8. Aksoy SB, Coşkun Ö, Gül HC, Görenek L, Eyigün PC. Enfeksiyon hastalıkları konsültasyon hizmetlerinin antibiyotik kullanımı, direnç ve maliyet üzerindeki etkisi, Gülhane Tıp Derg. 2008; 50: 71-7.
  • 9. Resmî gazete [İnternet]. Bütçe uygulama talimatı [erişim 17 Temmuz 2019]. http://www.resmigazete.gov.tr/eskiler/2003/02/20030201.htm#7.
  • 10. Yinnon AM. Whither infectious diseases consultations? Analysis of 14005 consultations from a 5 year period. Clin Infect Dis 2001; 33: 1661-7.
  • 11. Nathwani D, Davey P, France AJ. Impact of an infection consultation service for bacteremia on clinical management and use of resources. Quart J Med 1996; 89: 789-97.
  • 12. Bruno P. Dimitrios P. The impact of infectious diseases consultation on oncology practice. Curr Opin Oncol 2013; 25: 353–9.
  • 13. Özsüt H, Eraksoy H, Dilmener M, Çalangu S, İnfeksiyon hastalıkları konsültasyonlarında karşılaşılan sorunlar ve çözüm yolları. Klimik Derg. 1994; 2: 101-2.
  • 14. Sharma R, Loomis W, Brown RB. Impact of mandatory inpatient infectious disease consultation on outpatient parenteral antibiotic therapy. Am J Med Sci 2005; 330: 60–4.
  • 15. Shrestha NK, Bhaskaran A, Scalera NM, et al. Antimicrobial stewardship at transition of care from hospital to community. Infect Control Hosp Epidemiol 2012; 33: 401–4.
  • 16. Singer C, Kaplan MH, Armstrong D. Bacteremia and fungemia complicating neoplastic disease. A study of 364 cases. Am J Med 1977; 62: 731–42.
  • 17. Honda H, Krauss MJ, Jones JC, et al. The value of infectious diseases consultation in Staphylococcus aureus bacteremia. Am J Med 2010; 123: 631–7.
  • 18. Patel M, Kunz DF, Trivedi VM, et al. Initial management of candidemia at an academic medical center: evaluation of the IDSA guidelines. Diagn Microbiol Infect Dis 2005; 52: 29–34.
  • 19. Takakura S, Fujihara N, Saito T, et al. Improved clinical outcome of patients with Candida bloodstream infections through direct consultation by infectious diseases physicians in a Japanese university hospital. Infect Control Hosp Epidemiol 2006; 27: 964–8.
  • 20. Forsblom E, Ruotsalainen E, Ollgren J, Jarvinen A. Telephone consultation cannot replace bedside infectious disease consultation in the management of Staphylococcus aureus bacteremia. Clin Infect Dis 2013; 56: 527–35.
  • 21. Pongas G, Hamilos G, Rolston KV, Kontoyiannis DP. Formal adult infectious disease specialist consultations in the outpatient setting at a comprehensive cancer center (1998–2008): diverse and impactful. Support Care Cancer 2012; 20: 261–5.
There are 21 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Original Article
Authors

Fatih Temoçin 0000-0002-4819-8242

Levent Şensoy 0000-0002-5064-2656

Tuba Duman Karakuş 0000-0001-7333-0789

Aynur Atilla 0000-0001-8027-1991

Tuba Kuruoğlu 0000-0002-7505-341X

Esra Tanyel 0000-0002-3151-371X

Publication Date June 18, 2020
Published in Issue Year 2020 Volume: 3 Issue: 3

Cite

AMA Temoçin F, Şensoy L, Duman Karakuş T, Atilla A, Kuruoğlu T, Tanyel E. Enfeksiyon hastalıkları ve klinik mikrobiyoloji kliniğinin konsültasyon iş yükü. J Health Sci Med / JHSM. June 2020;3(3):324-329. doi:10.32322/jhsm.738660

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