Action 6:
Seek advice for
complex cases
Involvement of infectious diseases (ID)
Key points:

Involve infectious diseases (ID) specialists and
clinical microbiologists in the management of
patients with severe or complex infections

Ensure local policies include a list of infections
specialists and clinical microbiologists in the
and clinical conditions where advice should be
management of patients with serious infections
sought from an ID specialist and/or clinical
can help to improve patient outcomes.
microbiologist
These specialists can provide advice

Where specialist ID or microbiology services are
about appropriate drug choice, dosing regimen
not available on site, health services should aim to
and duration of therapy, as well as assessment
have arrangements in place to access this
of response to therapy.1
expertise
Consultation with an ID specialist is an important
clinical strategy for minimising inappropriate antibiotic treatment which can be associated with increased morbidity
and mortality.2, 3 Several studies have shown that patient outcomes are improved when ID specialists are
consulted.4-7
Organisational antibiotic policies should include a list of infections and clinical conditions where early consultation
or advice from an ID specialist and/or clinical microbiologist is advised. Such clinical conditions or infections might
include:1
-
bloodstream infection/sepsis
-
fever of unknown origin or where response to empiric antibiotic treatment is poor
-
infected joint replacements (early or late)
-
bacterial meningitis (suspected or proven)
-
osteomyelitis
-
multi-drug resistant bacterial infections
-
infections in the immunosuppressed patient
-
patients with significant allergies to antibiotic agents
Not all health care organisations will have access to onsite specialist infectious diseases or microbiology services.
Where this is the case, hospitals and health service organisations may need to have arrangements in place to
access experts to provide individual patient advice to prescribers. This could be arranged through visiting clinicians,
networks and/or contracts for professional clinical services. Advice may be able to be provided over the phone, via
teleconferencing or videoconference.
Useful resources
The Antimicrobial Stewardship (AMS) Clinical Care Standard.
The Antimicrobial Stewardship (AMS) Clinical Care Standard aims to ensure that a patient with a
bacterial infection receives optimal treatment with antibiotics. It provides advice to clinicians,
consumers and health services on key components of care related to antibiotic therapy. The AMS
Clinical Care Standard is due for publication late 2014. For more information, visit
www.safetyandquality.gov.au/ccs
References and further reading
1.
Duguid M, Cruickshank M (editors). Antimicrobial Stewardship in Australian Hospitals. Sydney: Australian
Commission on Safety and Quality in Health Care, 2011.
2.
Kollef M. Inadequate antimicrobial treatment: an important determinant of outcome for hospitalized patients.
Clinical Infectious Diseases 2000;31(Suppl 4):S131-S138.
3.
Drew R, White R, MacDougall C, Hermsen E, Owens R, Jr, Society of Infectious Diseases Pharmacists.
Insights from the Society of Infectious Diseases Pharmacists on antimicrobial stewardship guidelines from
the Infectious Diseases Society of America and the Society of Epidemiology of America. Pharmacotherapy
2009;29(5):593-607.
4.
MacArthur R, Miller M, Albertson T, Panacek E, Johnson D, Teoh L, Barchuk W. Adequacy of early empiric
antibiotic treatment and survival in severe sepsis: experience form the MONARCS trial. Clinical Infectious
Diseases 2004;38:284-288.
5.
Petrak R, Sexton D, Butera M, Tenenbaum M, MacGregor M, Schmidt M, Kemmerly JW, Dougherty M,
Bakken J, Curfman M, Martinelli L, Gainer R. The value of an infectious diseases specialist. Clinical
Infectious Diseases 2003;36:1013-1017.
6.
Byl B, Clevenbergh P, Jacobs F, Struelens M, Zech F, Kentos A, Thys J. Impact of infectious diseases
specialists and microbiology data on the appropriateness of antimicrobial therapy for bacteremia. Clinical
Infectious Diseases 1999;29:60-66.
7.
Filice G, Abraham J. Infectious diseases involvement for Staphylococcus aureus bacteremia was associated
with appropriate therapy and fewer relapses. 48 th Interscience Conference on Antimicrobial Agents and
Chemotherapy. Washington DC, 2008: Abstract K3471.
Date of publication: 24 October 2014
This document is intended for use by health professionals. It has been created from information contained in Antimicrobial Stewardship in
Australian Hospitals 2011 and reviewed by clinical experts. Reasonable care has been taken to ensure this information is accurate at the date of
creation. This fact sheet is intended to be used in its original version and can be downloaded from the Australian Commission on Safety and
Quality in Health Care web page www.safetyandquality.gov.au
“No action today, no cure tomorrow” is adopted from the WHO World Health Day 2011.
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