Positive blood culture in hospital: notification methods and impact of recommendations by an infectious disease specialist.
OBJECTIVE
The study's objective was to describe the notification methods of positive blood cultures and analyse the impact of recommendations made by an infectious disease specialist on the appropriateness of antibiotherapy.


METHODS
We included all patients with positive blood cultures, from 12 different hospitals (including six with mobile infectious disease teams: MIDT) during a seven-day period. Medical records were retrospectively analysed to determine the delivered antibiotic treatment and the notification method of positive blood culture. We considered that the antibiotic treatment was appropriate if the antibiotic was effective on the isolated bacterium, whatever its spectrum. We assessed the impact of recommendations on appropriateness of antibiotherapy.


RESULTS
One hundred and eighty-six patients were included. 44% (n=86) were considered as contamination cases. In true infections (n=104), Staphylococcus aureus and enterobacteria accounted for 51% of isolated bacteria. The Medical Unit was notified of blood culture positivity the day of positivity in 98% of cases (n=182). Antibiotic recommendations were given on the same day in 71% of cases. The antibiotic treatment was appropriate if recommendations were given in 92% of bacteremia, and only in 79% in without any recommendations (P=0.1).


CONCLUSIONS
Antibiotic treatment seems to be more appropriate when antibiotic recommendations are given. This suggests that the MIDT has a key role in improving antibiotic prescriptions, whether for effectiveness, cost, or bacterial ecology.
Service de médecine interne et maladies infectieuses, CHI Robert-Ballanger, boulevard Robert-Ballanger, 93600 Aulnay-sous-Bois, France. helene.gros@ch-aulnay.fr
H
H
Gros
E
E
Aslangul
P
P
Lesprit
J-L
JL
Mainardi
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D001769:Blood / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D018563:Disease Notification / Q000379:methods*; D004352:Drug Resistance, Microbial; D005189:False Positive Reactions; D006747:Hospital Communication Systems; D006753:Hospital Records; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D055552:Infectious Disease Medicine / Q000592:standards*; D008485:Medical Audit; D010297:Paris / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents