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Impact of infectious diseases specialists and microbiological data on the appropriateness of antimicrobial therapy for bacteremia.

par Byl, Baudouin ;Clevenbergh, Philippe;Jacobs, Frédérique ;Struelens, Marc ;Zech, Francis;Kentos, Alain ;Thys, Jean-Pierre
Référence Clinical infectious diseases, 29, 1, page (60-6; discussion 67-8)
Publication Publié, 1999-07

Article révisé par les pairs

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Résumé :

Antimicrobial therapy for 428 episodes of bacteremia in an 850-bed university hospital was prospectively evaluated for 1 year to measure the impact of two factors--blood culture results and the therapy chosen by infectious diseases specialists (IDSs)--on quality of treatment and outcome. Initial shock, a simplified acute physiology score of >15, and inappropriateness of the empirical treatment were independently associated with increased mortality. Empirical treatment was appropriate in 63% of the episodes. This proportion reached 78% for the episodes treated by IDSs, compared with 54% for the others (P < .001). After availability of blood culture results, the proportion of appropriate treatments increased to 94%, with 97% for IDS-treated patients and 89% for other patients (P = .008). IDSs more frequently shifted to oral antibiotics and used fewer broad-spectrum drugs. This study underlines the impact of blood culture results and of IDSs on the prescription of appropriate treatment for bacteremia and on the better use of antimicrobial drugs.