From the Guidelines
An Infectious Disease (ID) specialist should be consulted for complex infections that require specialized expertise beyond what primary care physicians or other specialists can provide, particularly in cases of severe infections, immunocompromised patients, and multidrug-resistant organisms. Consultation is recommended for severe infections requiring hospitalization, infections that don't respond to initial treatment, unusual or rare infections, infections in immunocompromised patients (such as those with HIV/AIDS, transplant recipients, or cancer patients on chemotherapy), complicated surgical or device-related infections, and management of multidrug-resistant organisms. ID specialists should also be involved in cases of travel-related infections, tuberculosis, endocarditis, osteomyelitis, HIV/AIDS management, complicated pneumonia, meningitis, and unexplained fevers of unknown origin. Early consultation is beneficial as ID specialists have extensive training in identifying pathogens, selecting appropriate antimicrobial therapy (including optimal drug selection, dosing, and duration), managing drug interactions and adverse effects, and implementing antimicrobial stewardship to prevent resistance, as noted in the guidelines for managing sepsis and septic shock 1. Their expertise often leads to more accurate diagnoses, more effective treatment plans, reduced complications, shorter hospital stays, and better patient outcomes.
Some key scenarios where ID specialist consultation is particularly valuable include:
- Severe infections requiring hospitalization, such as those involving septic shock or severe sepsis, where prompt and appropriate antimicrobial therapy is crucial 1
- Infections in immunocompromised patients, such as those with HIV/AIDS or undergoing chemotherapy, who are at higher risk of complications and may require specialized management 1
- Management of multidrug-resistant organisms, where ID specialists can provide guidance on optimal treatment strategies and help prevent further resistance development 1
- Cases of endocarditis, osteomyelitis, or other complex infections that require prolonged antimicrobial therapy and close monitoring, as outlined in guidelines for infective endocarditis 1
Involving ID specialists early in the management of complex infections can significantly improve patient outcomes by ensuring that patients receive the most appropriate and effective treatment, and by reducing the risk of complications and antimicrobial resistance, as supported by guidelines for various infectious diseases 1.
From the Research
When to Consult an Infectious Disease Specialist
- Immunocompromised patients, who account for about 3% of the US population, should be consulted by an ID specialist due to the complexity of their condition and the high risk of complications from infections 2.
- Patients with severe respiratory infections, particularly those with acute hypoxemic respiratory failure, should be evaluated by an ID specialist to determine the cause of the infection and guide treatment 3.
- In cases of bloodstream infections, especially in critically ill patients, an ID specialist should be consulted to ensure early adequate antimicrobial therapy and to guide the choice of antimicrobials based on local epidemiology and patient factors 4.
- Complex clinical cases that do not match typical patterns, or those with high levels of uncertainty, may benefit from consultation with an ID specialist, who can use cognitive strategies such as watchful waiting, theory of mind, heuristics, anticipatory thinking, and peer consultation to manage decision complexity 5.
- Patients with osteomyelitis, particularly those with complex cases or those that do not respond to initial treatment, may require consultation with an ID specialist to guide antimicrobial therapy and ensure optimal outcomes 6.