title: Impact of infectious diseases specialists and microbiological data on the appropriateness of antimicrobial therapy for bacteremia.
abstract: 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.
authors.affiliation: Infectious Diseases Clinic and Microbiology Department, Erasme Hospital, Free University of Brussels, Belgium. baudouin.byl@ulb.ac.be
authors.forename: B
authors.initials: B
authors.lastname: Byl
authors.forename: P
authors.initials: P
authors.lastname: Clevenbergh
authors.forename: F
authors.initials: F
authors.lastname: Jacobs
authors.forename: M J
authors.initials: MJ
authors.lastname: Struelens
authors.forename: F
authors.initials: F
authors.lastname: Zech
authors.forename: A
authors.initials: A
authors.lastname: Kentos
authors.forename: J P
authors.initials: JP
authors.lastname: Thys
mesh_terms: D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D006801:Humans; D007275:Injections, Intravenous; D008511:Medicine; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D013038:Specialization; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents