Evaluation of Informal Opinions of the Infectious Disease Specialist Referent for the Good Use of AnTiBiotics in General Medicine

1. Current knowledge on the problem

The increase in bacterial resistance and the overuse of antibiotics have led health authorities to propose incentives for the proper use of antibiotics. Among these measures are public awareness campaigns, the establishment of antibiotic reference materials and the development of indicators of appropriate use in health facilities.

In response to these issues, the infectiology teams have developed cross-cutting activities to improve antibiotic prescribing in their healthcare institutions: drafting and implementing clinical practice recommendations; initial and continuing training of prescribers in the proper use of antibiotics; evaluation of practices for the management of infectious diseases; organization of collaborations with the CLIN, microbiology laboratories and pharmacy; monitoring and analysis of antibiotic dispensing, monitoring and analysis of bacterial resistance.

Some teams have set up prescription support systems to meet the growing demand from non-infectious disease clinicians and to satisfy the criteria of the Composite Indicator of Antibiotic Use (ICATB 2), which relates to "access to antibiotic therapy advice". In 2000, the cross-disciplinary infectiology team at Grenoble Alpes University Hospital set up a "Mobile Infectiology Consultation (MIC)" based on a cell phone medical service available 24 hours a day, 7 days a week. This team carried out an analysis of all the informal consultations treated by this "hotline" during 2008. 7863 advice was given during the study period; 37.3% of them within the University Hospital Center to adapt or start antibiotic therapy. This activity has developed significantly and is now well established in France in the hospital environment. The Grenoble team conducted a new evaluation in 2016 and recorded nearly 16,000 calls per year (publication in progress).

Studies of intra-hospital infectious disease teleadvisory services have shown that compliance with infectious disease advice reduces the consumption of anti-infectives and improves the prognosis of hospitalized patients. Thus Sellier et al reported the results of a prospective study carried out on 621 patients benefiting from infectious disease counseling. Adherence to the advice given was good 88.2% (548/621). When counseling was followed clinical improvement at D3 was more frequent (60.7% versus 43.9%, p=0.01) and the median duration of hospitalization was 3 days shorter (20 days versus 23, p=0.03). Adherence to telephone advice was comparable to that of formal advice given during a consultation, out of a series of 627 consecutive advice sessions reported by the same team. These results are supported by other studies that highlight the positive impact of informal consultation with infectious disease specialists on the management of inpatients, particularly in intensive care units.