The impact of blood culture reporting and clinical liaison on the empiric treatment of bacteraemia.
OBJECTIVE
To assess the impact of blood culture results and early clinical liaison on the treatment of patients with bacteraemia.


METHODS
123 patients with significant positive blood cultures were followed over a nine month period in a 620 bed teaching hospital. The impact of early blood culture reporting and clinical liaison on the cost and appropriateness of treatment was assessed.


RESULTS
Empiric treatment was started before the Gram stain result in 107 (87%) patients. Treatment was altered on the basis of the Gram stain result in 39 (36%) of these patients, and on culture and sensitivity results in 53 (50%). The spectrum of antibiotic treatment was narrowed in 58 (54%) of these; 20 (19%) on Gram stain result alone. This resulted in a 42% reduction in daily antibiotic costs in patients who had received empiric treatment. Empiric treatment did not follow the hospital antibiotic policy in 49 (46%) of the patients treated. In patients where empiric treatment was not in accordance with hospital policy, 21 (44%) had an isolate resistant to the empiric treatment used; while in patients who received agents in accordance with hospital policy only one (1.7%) had a resistant isolate (p < 0.05). Patients who died (11 (9%)) were less likely to have received empiric treatment in accordance with the antibiotic policy, although this did not reach statistical significance (p = 0.1).


CONCLUSIONS
Early reporting of Gram stain results from blood cultures, combined with early clinical liaison, results in more rational and cost effective treatment.
Cunney
R J
RJ
Department of Clinical Microbiology, Royal College of Surgeons, Dublin 9, Ireland.
McNamara
E B
EB
Alansari
N
N
Loo
B
B
Smyth
E G
EG
D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy*; D002985:Clinical Protocols; D019983:Guideline Adherence; D017721:Hospital Costs; D006784:Hospitals, Teaching; D006801:Humans; D007755:Laboratories, Hospital; D008485:Medical Audit; D008499:Medical Records; D008828:Microbiological Techniques; D011446:Prospective Studies; D013997:Time Factors
D000900:Anti-Bacterial Agents