A. Martin , Y. Ruch , N. Douiri , P. Boyer , X. Argemi , Y. Hansmann , N. Lefebvre
{"title":"传染病专家建议后治疗失败的相关因素","authors":"A. Martin , Y. Ruch , N. Douiri , P. Boyer , X. Argemi , Y. Hansmann , N. Lefebvre","doi":"10.1016/j.medmal.2019.11.003","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>Risk factors associated with treatment failure after the infectious disease specialist's (IDS) advice remain unknown. We aimed to identify these risk factors.</p></div><div><h3>Methods</h3><p>We included patients hospitalized in our tertiary care center who consulted an infectious disease specialist between January 2013 and April 2015. Treatment failure was defined by a composite criterion: signs of sepsis beyond Day 3, ICU admission, or death. Treatment success was defined by the patient's sustained clinical improvement.</p></div><div><h3>Results</h3><p>A total of 240 IDS recommendations were made. Diagnosis was changed for 64 patients (26.7%) and 50 patients experienced treatment failure after the IDS advice. In multivariate analysis, compliance with the IDS advice was associated with a higher rate of success (OR<!--> <!-->=<!--> <!-->0.09, 95%CI [0.01–0.67]). Variables associated with treatment failure in the multivariate analysis were Charlson comorbidity score at admission (OR<!--> <!-->=<!--> <!-->1.24, 95%CI [1.03–1.50]), a history of infection or colonization with multidrug-resistant bacteria (OR<!--> <!-->=<!--> <!-->8.27, 95%CI [1.37–49.80]), and deterioration of the patient's status three days after the IDS advice (OR<!--> <!-->=<!--> <!-->12.50, 95%CI [3.16–49.46]).</p></div><div><h3>Conclusion</h3><p>Reassessing IDS recommendations could be interesting for specific patients to further adapt and improve them.</p></div>","PeriodicalId":18464,"journal":{"name":"Medecine et maladies infectieuses","volume":"50 8","pages":"Pages 696-701"},"PeriodicalIF":5.0000,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.medmal.2019.11.003","citationCount":"0","resultStr":"{\"title\":\"Factors associated with treatment failure after advice from infectious disease specialists\",\"authors\":\"A. Martin , Y. Ruch , N. Douiri , P. Boyer , X. Argemi , Y. Hansmann , N. Lefebvre\",\"doi\":\"10.1016/j.medmal.2019.11.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>Risk factors associated with treatment failure after the infectious disease specialist's (IDS) advice remain unknown. We aimed to identify these risk factors.</p></div><div><h3>Methods</h3><p>We included patients hospitalized in our tertiary care center who consulted an infectious disease specialist between January 2013 and April 2015. Treatment failure was defined by a composite criterion: signs of sepsis beyond Day 3, ICU admission, or death. Treatment success was defined by the patient's sustained clinical improvement.</p></div><div><h3>Results</h3><p>A total of 240 IDS recommendations were made. Diagnosis was changed for 64 patients (26.7%) and 50 patients experienced treatment failure after the IDS advice. In multivariate analysis, compliance with the IDS advice was associated with a higher rate of success (OR<!--> <!-->=<!--> <!-->0.09, 95%CI [0.01–0.67]). Variables associated with treatment failure in the multivariate analysis were Charlson comorbidity score at admission (OR<!--> <!-->=<!--> <!-->1.24, 95%CI [1.03–1.50]), a history of infection or colonization with multidrug-resistant bacteria (OR<!--> <!-->=<!--> <!-->8.27, 95%CI [1.37–49.80]), and deterioration of the patient's status three days after the IDS advice (OR<!--> <!-->=<!--> <!-->12.50, 95%CI [3.16–49.46]).</p></div><div><h3>Conclusion</h3><p>Reassessing IDS recommendations could be interesting for specific patients to further adapt and improve them.</p></div>\",\"PeriodicalId\":18464,\"journal\":{\"name\":\"Medecine et maladies infectieuses\",\"volume\":\"50 8\",\"pages\":\"Pages 696-701\"},\"PeriodicalIF\":5.0000,\"publicationDate\":\"2020-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1016/j.medmal.2019.11.003\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Medecine et maladies infectieuses\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0399077X19310716\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medecine et maladies infectieuses","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0399077X19310716","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
Factors associated with treatment failure after advice from infectious disease specialists
Objective
Risk factors associated with treatment failure after the infectious disease specialist's (IDS) advice remain unknown. We aimed to identify these risk factors.
Methods
We included patients hospitalized in our tertiary care center who consulted an infectious disease specialist between January 2013 and April 2015. Treatment failure was defined by a composite criterion: signs of sepsis beyond Day 3, ICU admission, or death. Treatment success was defined by the patient's sustained clinical improvement.
Results
A total of 240 IDS recommendations were made. Diagnosis was changed for 64 patients (26.7%) and 50 patients experienced treatment failure after the IDS advice. In multivariate analysis, compliance with the IDS advice was associated with a higher rate of success (OR = 0.09, 95%CI [0.01–0.67]). Variables associated with treatment failure in the multivariate analysis were Charlson comorbidity score at admission (OR = 1.24, 95%CI [1.03–1.50]), a history of infection or colonization with multidrug-resistant bacteria (OR = 8.27, 95%CI [1.37–49.80]), and deterioration of the patient's status three days after the IDS advice (OR = 12.50, 95%CI [3.16–49.46]).
Conclusion
Reassessing IDS recommendations could be interesting for specific patients to further adapt and improve them.
期刊介绍:
L''organe d''expression de la Société de Pathologie Infectieuse de Langue Française (SPILF).
Médecine et Maladies Infectieuses is the official publication of the Société de Pathologie Infectieuse de Langue Française (SPILF). Médecine et Maladies Infectieuses is indexed in the major databases: Medline, Web of Science/Clarivate and Scopus. The journal publishes scientific /research articles, general reviews, short communications and letters, in both English and French. The journal welcomes submissions on the various aspects of infectious pathologies and pathogenic agents. Médecine et Maladies Infectieuses focuses on clinical therapeutics, nosocomial infections, biology, prevention, as well as epidemiology and therapeutics.