The Characteristics of Patients Referred to an Infectious Diseases Physician in a Community-Based Hospital in Korea / 감염과화학요법

ABSTRACT

BACKGROUND: The infectious diseases physicians will increasingly make their way into the community. But there is few data about the role of the infectious diseases physicians in the community in Korea. MATERIALS AND METHODS: Patients admitting to a division of infectious diseases in a community-based tertiary hospital were analyzed retrospectively during 24 months from 2004. The analysis included patients characteristics, the pattern of referral, causative diseases, the type of infectious diseases, causative organisms, diagnostic methods, and the feature of fever of unknown origin (FUO). RESULTS: 362 patients were included. 64.1% admitted via emergency room with significantly higher severity. 51.1% of patients had referral impression of FUO. The average duration of admission was 10.7 days with median 5 days. The patients had infectious diseases in 81.8%, non-infectious diseases in 5.2%, and unknown causes in 13.0%. The causative infectious diseases included scrub typhus (25.3%), skin and soft tissue infections (16.6%), lower respiratory infections (13.9%) and urinary tract infections (10.8%). The diagnostic tools for the causative organisms included culture (34.8%), serology (28.7%), staining (5.6%) and the clinical decision (30.3%). The causes of FUO were infectious diseases in 71.9 %, non-infectious diseases in 6.0% and unknown in 22.1%. The overall mortality rate was 6.9%. CONCLUSION: Most of the diseases referred to an infectious diseases physician in the community were community-acquired febrile infectious diseases with high severity, which needed conventional diagnostic principles in infectious diseases and an initial intensive therapeutic approach. The relative high incidence of skin and soft tissue infections were notable. Self-transfer by patients to several well- known hospitals was noted if there was no definite diagnosis in about a week after admission. This indicated a limitation of sophisticated FUO work-up in a community-based hospital without high name value.