Periodic Infectious Disease Consultation with a Visiting Specialist in an Urban General Hospital in Japan

[Abstract] The importance of infectious disease (ID) consultation in a hospital setting has been increasing. However, little information has been reported regarding visiting ID consultation in hospitals without ID physicians. We aimed to summarize our experience of weekly visiting ID consultations by ID specialists. A visiting ID consultation was implemented every Friday in an urban general hospital with 369-beds in Fukuoka, Japan. The diagnosis, treatment, and prognosis of patients treated from June 2017 to May 2018 were analyzed. There were a total of 110 ID consultation cases during the study period. Hospital-acquired diseases accounted for approximately 40% (40/110), of which consulting cases from surgical physicians were more common than those from internal medicine physicians (25/44 vs. 15/66, P = 0.0005). Blood cultures were performed before consultation in 61.8% (68/110) cases, and the collection rate in the pulmonary cases (20/46, 43.5%) was significantly lower than in the non-pulmonary cases (48/64, 75.0%) (P = 0.0008). Targeted/de-escalating antimicrobial therapy was conducted at a significantly lower frequency in the patients with no or unconfirmed bacteremic diseases (11/60, 18.3%), compared to patients with bacteremic diseases (30/34, 88.2%) (P ＜ 0.0001). Of the 110 cases, 21 (19.1%) continued to worsen (2/21) or died (19/21) within 30 days after consultation. Our experience with visiting ID consultation underscores the importance of microbiological examinations, especially blood cultures, for pathogen identification and subsequent suitable therapy. Continued data collection in this field is warranted.