Impact of infectious diseases specialists and microbiological data on the appropriateness of antimicrobial therapy for bacteremia

Antimicrobial therapy for 428 episodes of bacteremia in an 850-bed universi ty hospital was prospectively evaluated for 1 year to measure the impact of two factors-blood culture results and the therapy chosen by infectious dis eases 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 proportio n reached 78% for the episodes treated by IDSs, compared with 54% for the o thers (P < .001). After availability of blood culture results, the proporti on of appropriate treatments increased to 94%, with 97% for IDS-treated pat ients and 89% for other patients (P = .008). IDSs more frequently shifted t o oral antibiotics and used fewer broad-spectrum drugs. This study underlin es the impact of blood culture results and of IDSs on the prescription of a ppropriate treatment for bacteremia and on the better use of antimicrobial drugs.