IMPLEMENTATION OF CONSENSUS GUIDELINES FOR THE FOLLOW-UP OF POSITIVE BLOOD CULTURES

OBJECTIVE: Assess the effect and use of resources associated with impl ementation of a program for the systematic follow-up of positive blood cultures. DESIGN: Prospective epidemiologic study. SETTING: Tertiary- care military medical center. INTERVENTION: All positive blood culture s (BC) were reported via E-mail to an infectious disease specialist as soon as growth was noted. This individual reviewed all Gram stains, c linical data, and antibiotic information on these patients. RESULTS: F rom June 26, 1994, through January 25, 1995, there were 3,121 BCs draw n, of which 199 (6.4%) were positive from 145 episodes. Sixty-three ep isodes involved probable contaminants, and 82 episodes were considered true bacteremias. Six patients with true bacteremia died, two were tr ansferred, and three were discharged within 24 hours of drawing the po sitive BC. Of the remaining 71 true bacteremias, 9 patients were on in adequate empiric therapy, as judged by the final organism susceptibili ties. Changes in empiric therapy were recommended for five of the nine episodes and were implemented by the primary physicians in each case, Each of the changes resulted in improved coverage (as judged by the f inal identification and susceptibilities). CONCLUSIONS: This program h as improved the quality of care at Keesler Medical Center at the cost of one additional hour of consultant time per week.