IMPACT OF AN INFECTION CONSULTATION SERVICE FOR BACTEREMIA ON CLINICAL MANAGEMENT AND USE OF RESOURCES

Since 1993, the infection consultation service for bacteraemia has see n 310 patients in the Medical and Surgical Directorates at Ninewells H ospital and Kings Cross Hospital. A random sample of 100 was audited. Case-notes were incomplete for five patients, leaving 95 fully-audited patients. Clinical outcome measures were death from infection, and re admission within 2 weeks of discharge. Initial treatment was inconsist ent with antibiotic policy in 46 patients (48%). Antibiotic treatment was changed in 37 (80%) of these patients: increased in intensity in 1 9 (41%) and decreased in 18 (39%). Changes were also made in 30 (61%) of the 49 patients whose initial treatment was consistent with sepsis policy-increased in seven (14%) and decreased in 23 (47%). Median dail y antibiotic costs were lowered in patients whose initial treatment wa s consistent with sepsis policy (pound 10.10 vs. pound 7.28, p=0.0274) . However, in the other patients, savings were balanced by increases ( p=0.7696). Consultation required one consultant session per week (3.5 h) and the audit required an additional 16 consultant sessions. Seven patients died, but only one death was directly related to infection. S ix patients were readmitted to hospital within 2 weeks, in three due t o recurrence of infection. Changes to treatment were recommended in th e majority of patients, regardless of whether initial treatment compli ed with the sepsis policy. The service primarily redistributed resourc es rather than reducing costs. A fully audited service requires consid erable consultant time, but we believe such time is well spent.