Definition and Role of an Infectious Diseases Specialist
An infectious diseases specialist is a physician with expertise in the diagnosis and treatment of infectious diseases who serves as the primary coordinator of antimicrobial stewardship programs, provides consultation for complex infections, and applies in-depth knowledge of medical and laboratory science along with principles of epidemiology and antibiotic pharmacokinetics to optimize patient outcomes. 1
Core Definition and Expertise
An infectious diseases specialist possesses versatile attributes that integrate multiple domains of medical knowledge 2:
- Diagnostic expertise: Applies in-depth knowledge of both medical and laboratory science along with principles of epidemiology and pharmacokinetics of antibiotics, integrating a strategic view of host-parasite interactions 1
- Specialized training: Requires appropriate and specific training, primarily using the instrumentarium of internal medicine, with certification through recognized boards 1, 3
- Broad clinical scope: Addresses diverse, sometimes massive outbreaks, identifies specific disease causes (microbes), and deals with the ability to cure and prevent disease 4
Primary Clinical Responsibilities
Direct Patient Care
- Consultation for serious infections: Should be consulted at the first sign of a serious infection, as involvement in complex infections has shown to reduce mortality by approximately 50% 1, 5
- Optimal treatment determination: Collaborates with appropriate medical specialists to determine optimal nonsurgical treatment for infectious complications 1
- Diagnostic partnership: Serves as one of the most valuable laboratory partners in infectious disease diagnosis, particularly specialists certified as Diplomates by recognized boards 1
Antimicrobial Stewardship Leadership
A multidisciplinary antimicrobial stewardship team must be coordinated by an infectious disease specialist, or by another specialist with documented infectious skills. 1
The infectious disease specialist leads the stewardship team which includes 1, 6:
- Clinical pharmacists with advanced training in infectious diseases
- Infection control specialists and hospital epidemiologists
- Microbiologists who provide surveillance data on antimicrobial resistance
- Surgeons with knowledge in surgical infections
- Intensivists for critically ill patients
- Emergency department practitioners
- Hospital administrators for resource allocation
Infection Control and Prevention
- Surveillance and monitoring: Coordinates efforts on monitoring and preventing healthcare-associated infections, including surveillance cultures for carbapenem-resistant organisms 1, 6
- Outbreak management: Addresses emerging infections and rising rates of antibiotic resistance through international and local collaborations 3
- Public health interface: Guards antibiotics and fights resistance as a response to the global antimicrobial resistance crisis 5
Specialized Areas of Practice
Laboratory Collaboration
- Specimen management consultation: Provides consultation for proper specimen selection, collection, transport, and storage to ensure accurate laboratory diagnosis 1
- Microbiology interpretation: Maintains dialogue with the clinical laboratory to ensure appropriate tests are ordered and interpreted in the context of the patient's clinical status 1
- Genomic testing guidance: Uses genomic tests that identify microbial contributors to human health and disease, as well as genomic tests that guide therapeutics 1
Complex Clinical Scenarios
- Neuraxial infection complications: Provides expertise in diagnosis and treatment when serious neuraxial infections are suspected, including epidural abscesses 1
- Diabetic foot infections: Serves as part of multidisciplinary foot care teams for inpatient management of diabetic foot problems 1
- COVID-19 and emerging infections: Engages in local-hospital, regional, or national guideline committees for emerging infectious diseases 1
- Unusual or resistant infections: Manages unusual or unexpected infections or infections that are highly resistant to treatment 1
Value to Healthcare Systems
The infectious disease specialist provides measurable value across multiple domains 2:
- Patient outcomes: Direct impact on patient care and outcomes, influencing therapeutic decisions and reducing mortality 1, 5
- Hospital efficiency: Impacts hospital infection control, patient length of stay, hospital costs, and laboratory costs 1
- Resource optimization: Contributes to optimizing treatment and limiting use of economic resources through appropriate diagnostic and therapeutic decisions 7
- Cost-effectiveness: Involvement in guideline-based care improves survival, reduces complications, and is cost-effective or even cost-saving compared with standard care 1
Critical Competencies
Clinical Decision-Making
- Antibiotic selection: Determines appropriate antibiotic therapy at the earliest sign or symptom of serious infection 1
- Treatment duration: Documents antibiotic indication and planned duration as part of quality improvement measures 6
- Resistance patterns: Interprets antimicrobial resistance patterns and surveillance data to guide empiric therapy 1, 6
Communication and Education
- Patient education: Explains results of microbial genomic testing to patients and provides guidance on avoiding transmission of microbial agents in the community 1
- Professional collaboration: Functions as a member of the care team, identifying appropriate specialists and public health officials who need to be included in patient care 1
- Institutional leadership: Makes themselves available for local-hospital, regional, or national guideline committees 1
Common Pitfalls and Considerations
- Not a substitute for stewardship: Antibiotic stewardship specialists should not be confused with or taken as an alternative to infectious disease experts, as infectious diseases requires appropriate and specific training 3
- Timely consultation: Consultation should occur promptly at the first sign of serious infection rather than waiting for complications to develop 1
- Multidisciplinary approach: The infectious disease specialist works within a team structure rather than in isolation, recognizing that optimal outcomes result from strong partnerships 1
- Resource constraints: Must balance individual patient needs with sensible use of antibiotics and healthcare resources, particularly in settings with limited specialist availability 6, 7