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- Title
Update on the "Choosing Wisely" initiative in infectious diseases in Germany.
- Authors
Draenert, Rika; Jung, Norma; the Choosing Wisely (Klug entscheiden) DGI Working Group; Addo, Marylyn M.; Berner, Reinhard; Bickel, Markus; Bogner, Johannes; Cornely, Oliver; de With, Katja; Fätkenheuer, Gerd; Hagel, Stefan; Hanses, Frank; Harrer, Thomas; Hartmann, Pia; Herold, Susanne; Hippenstiel, Stefan; Kern, Winfried; Klauke, Stephan; Klinker, Hartwig; Lehmann, Clara
- Abstract
Purpose: The Choosing Wisely® initiative is an international campaign addressing over- and underuse of diagnostic and therapeutic measures in infectious diseases among others. Since 2016, the German Society for Infectious Diseases (DGI) has constantly designed new items in this regard. Here we report the most recent recommendations. Methods: The recommendations of the DGI are part of the "Klug entscheiden" initiative of the German Society of Internal Medicine (DGIM). Topics for the new items were suggested by members of the DGI, checked for scientific evidence and consented within the DGI and the DGIM before publication. Results: The new recommendations are: (1) individuals with immune-suppression, advanced liver cirrhosis or renal insufficiency should receive a dual pneumococcal vaccination. (2) In case of positive blood cultures with Candida spp. thorough diagnostics and treatment should be initiated. (3) In case of suspected meningitis, adult patients should receive dexamethasone and antibiotics immediately after venipuncture for blood cultures and before potential imaging. (4) In case of suspected meningitis a CT scan before lumbar puncture should not be ordered—except for symptoms indicating high CSF pressure or focal brain pathology or in cases of severe immune-suppression. (5) In patients with suspected severe infections, a minimum of two pairs of blood cultures should be drawn using separate venipunctures prior to antibiotic therapy—regardless of body temperature. There is no need of a minimum time interval in between the blood draws. Conclusion: Applying these new Choosing Wisely® recommendations will increase patient safety and the value of health care.
- Subjects
GERMANY; ANTIBIOTICS; COMMUNICABLE disease diagnosis; PREVENTION of communicable diseases; COMMUNICABLE disease treatment; STREPTOCOCCAL disease prevention; BLOOD; CELL culture; COMPUTED tomography; HEALTH promotion; MEDICAL care use; MEDICAL protocols; MYCOSES; PATIENT safety; PNEUMOCOCCAL vaccines; LUMBAR puncture; VACCINES; DEXAMETHASONE; BACTERIAL meningitis
- Publication
Infection, 2020, Vol 48, Issue 3, p317
- ISSN
0300-8126
- Publication type
Article
- DOI
10.1007/s15010-020-01400-z