title: Applying a standard of care to the quality assessment of bacteremia.
abstract: OBJECTIVE
  To identify an indicator of appropriate antibiotic use for bacteremia that is scientifically sound, that is noncontroversial, and that can be broadly applied as an index of the quality of care.
  
  
  METHODS
  Retrospective review of consecutive cases of significant documented bacteremias.
  
  
  METHODS
  Suburban tertiary-care hospital.
  
  
  RESULTS
  Two hundred ninety-one of 300 (97%) patients received appropriate antibiotics within 48 hours after the final antibiotic sensitivity report was placed on the hospital chart. Therapy was not appropriate in 6 patients with methicillin-resistant Staphylococcus aureus and in 3 patients with enterococcal bacteremia.
  
  
  METHODS
  Following this study, we instituted a program to prospectively monitor antibiotic use in bacteremias. During the most recent 1-year period, the infectious disease fellow or pharmacist called the attending physician to change antibiotics in 84 of 731 (11.5%) patients with bacteremia. The program was well-accepted by attending physicians.
  
  
  CONCLUSIONS
  A scientifically sound, non-controversial standard of care was identified and used to evaluate the appropriateness of antibiotic use. When this standard was applied prospectively and incorporated into the hospital's routine operations, the quality of care was improved.
authors.affiliation: Department of Internal Medicine, Hackensack Medical Center, NJ 07601.
authors.forename: P A
authors.initials: PA
authors.lastname: Gross
authors.forename: Z K
authors.initials: ZK
authors.lastname: Saul
authors.forename: A
authors.initials: A
authors.lastname: Kuyumcu
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy*; D004352:Drug Resistance, Microbial; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy*; D006746:Hospital Bed Capacity, 500 and over; D006801:Humans; D008297:Male; D008485:Medical Audit; D008826:Microbial Sensitivity Tests; D009515:New Jersey; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents