VALUES AND ROLE OF INFECTIOUS DISEASE SPECIALTY
Many common infections can be dealt with by Family Practitioners, Medical Internists, Pediatricians and General Practitioners or by other subspecialty-trained doctors. Not each patient with an infectious illness has to be seen by an infectious disease (ID) specialist.
Infectious disease remains, however, among the leading causes of death worldwide for three reasons: (1) Emergence of new infectious diseases; (2) Re-emergence of old infectious diseases in new presentation; and (3) Persistence of intractable infectious illnesses, i.e. continuation of a pathophysiologic effect after the cause is removed and lingering management difficulties such as septic shock, meningitis, encephalitis, immune reconstitution inflammatory syndrome (IRIS), acquired hemophagocytic lymphohistiocytosis (HLH) disorders, etc. Therefore, there is a growing need for ID expertise to diagnose, manage and prevent further transmission of these infections in hospital and community settings.
Infectious disease is the subspecialty of adult medicine and pediatrics, dealing with the diagnosis and treatment of transmissible diseases of all types, in all organs and in all ages. Infectious disease specialists complement and strengthen therapeutic outcomes by providing the best care with proven benefits to the most ill patients in ICU settings, including those who have underlying malignancy and/or immunocompromised disorders. The contents and topics in the book have been selected from leading infectious diseases journals and reputed international professional societies. This book is concise and summarizes diagnostic and therapeutic information, with key practical points for quick and high-quality reference.
The aim is to provide standardized care for management, with particular emphasis on preventive and curative medical aspects. To achieve these objectives, ID specialists with their specialized knowledge of all kinds of infections—including those caused by bacteria, viruses, fungi and parasites—play a critical role in treating common and emerging new IDs in our clinical practices. Along with their specialized knowledge comes a particular insight into the use of antibiotics and their potential adverse effects. In special clinical situations, adjuvant immunotherapies including evolving monoclonal antibodies are chosen to control invasive diseases. Infectious disease specialists also have additional training in microbiology, immunology, epidemiology and infection control aspects, which are evolving constantly.
Recent focus is on improving cost effectiveness while increasing the quality of care. Infectious disease specialists oversee infection control and antibiotic stewardship programs and play a pivotal role in helping hospitals succeed in this new environment. Based on evidence-based medical (EBM) knowledge, it is imperative to improve treatment outcomes while reducing costs by avoiding unnecessary and, even harmful, therapeutic interventions. It is important to balance risks versus benefits in specific clinical situations, with the ultimate aim of improving patient outcomes.
Specialized Skills and Experiences
Infectious disease physicians, typically, have worked in academic medical centers with clinical and research training after achieving a Masters Degree in General Medicine and/or Pediatrics. Also have a varied number of clinical trainings leading to Fellowship or DM-ID qualifications. Many have passed a tough certification examination conducted by the accredited board on infectious diseases both in India and/or abroad.
What is the Role of an Infectious Disease Specialist in KIMS*?
- Treat full range of acute, recurrent and chronic infections including: Sepsis/Meningitis/Encephalitis/Pneumonia/Bone and Joints infections/ undifferentiated febrile illnesses that include tick-, mites- and mosquito-borne illnesses and widespread human zoonotic diseases/childhood Kawasaki disease/invasive parasitic and fungal diseases/antibiotic-resistant infections and other exotic onset diseases.
- Provides assistance in the selection of antibiotics, antivirals or other forms of therapy.
- Uses experience in caring for children with complicated infections including transplant and cancer patients.
- Infectious disease division activities are an important resource for the many adult and pediatric subspecialists at KIMS, as well as for primary care physicians.
- Provides support for hospital infection control and quality of care improvement initiatives, including antibiotic stewardship and CMEs programs.
- Communicates closely with the hospital microbiologists (Clinical Microbiologists) and infection control (IC) nursing staff on case management issues to formulate appropriate therapeutic planning and clinical follow-ups.
On a consult request, the ID specialist will review medical data (EMR) including radiographic and laboratory reports. Additional laboratory studies are often necessary and may include ordering appropriate cultures of biological body fluids, special serology and immunologic testing. Targeted molecular diagnostic studies (i.e. PCR) will be decided on clinical suspicion for unusual or uncommon diseases. These assays are done within the KIMS lab facility and/or through outsourcing to reference laboratories at the national and international levels.
Molecular diagnostics in the field of ID is the future, with a constant stream of new tests and new data. Molecular tests, with rapid turnaround times, for specific pathogens that can be done at the site of care make great sense for efficient care. Although enthusiasm for this new and more complex technology is great, there are also concerns about cost, the lack of sensitivity data, the inability to identify all pathogens and the difficulty in distinguishing from contaminants without quantitation.
When do you Need an Infectious Disease Specialist?
- Patients who present with an acute onset of undifferentiated febrile illnesses with a protracted clinical course despite initial therapeutic managements or when an infection is potentially serious.
- Provides special insight into tests that will be helpful in diagnosing and preventing recurrent infections.
- Assists with selecting targeted antibiotic(s) based on microbiologic test results.
How Infectious Disease Specialists work with Other Physicians?
- Evaluates and assists initial case management until patient stabilized.
- May continue to follow the case in outpatient department (OPD) after hospital discharge to review test results and to be sure that infection has been eliminated
- Infectious disease specialists may sometimes serve as primary care physicians for an emergency consult.
Apart from Clinical Care Responsibilities, the Hospital Infectious Disease Division Commits to:
- Expediting and coordinating with laboratory services, sorting out appropriate management strategies for clinically challenging cases.
- Emphasizing Antimicrobial-Stewardship theme and limiting emergence of antimicrobial resistance in our clinical settings.
- Incarnating the hospital ICC team's activities; the other core members of the team include clinical microbiologist (professional with an interest and experience in antimicrobial therapeutics), a healthcare epidemiologist and/or IC nursing staff, clinical pharmacist and an information systems specialist.
A hospital ID specialist's directed administrative role is the pivot for better patient care. A few important ID-related activities are:
- Communicate closely with healthcare workers (HCW) across the board, with the administrative hierarchy and prepare measures, policies/procedures for early disease detection. Formulate measures for effective prevention, and control of healthcare-associated infection, including the procedures to be followed in the event of an outbreak situation.
- Undertake, outline and updates a series of IDs management guidelines of clinical importance.
- Direct antimicrobial-management program and stewardship undertakings and adopt: a friendly approach to people to minimize drug-resistant organisms' prevalence in hospital environments.
- Emphasize appropriate use of newer anti-infective and antibacterial agents and also new uses for older antimicrobial agents. Work diligently on this.
- Coordinate with fetal and neonatology unit on maternal-newborn (NB) infection and, on diagnosis and prevention aspects.
- Ensure and direct Hospital Infection Control Committee (ICC) teams work and activities.
- Undertake and update a series of IDs management guidelines.
- Upkeep and sustain immunization coverage for adolescents adult, geriatric and pediatric age groups.
With this in mind, this handbook has been written in a 'teaching style', focusing on the diagnostic and therapeutic guidance that is essential in day-to-day clinical practice. The contents of the book should be of interest to medical students, clinical trainees and every medical specialists, including clinical microbiologists and pharmacists. The authors will greatly appreciate feedback from readers at email@example.com. These valuable inputs will be included in future editions of the handbook.