Clinical impact of an infectious disease service on the management of bloodstream infection

The impact of an infectious disease (ID) service on the optimal antibiotic management of 103 patients with bloodstream infections, defined as bacterem ia and systemic inflammatory response syndrome, was evaluated. The optimal antibiotic management was defined according to the Sanford Guide to Antimic robial Therapy (1996) or written internal guidelines. The judgment on optim al antibiotic management was made at the time of reporting the positive blo od culture results. Switching from a broad-spectrum to a narrow-spectrum ag ent was carried out significantly more often by the ID service than by the attending physicians (25 of 25 vs. 20 of 40; P<0.001). In patients without empirical therapy, the ID service initiated optimal antimicrobial therapy s ignificantly more often than physicians without training in infectious dise ases (12 of 12 vs. 4 of 10, P = 0.0028). Three of 12 patients in whom the a ttending physician misinterpreted the positive blood culture result needed 8 days to 4 months of additional hospitalization. In summary, patients for whom an ID service was provided received appropriate treatment more often a nd experienced significantly fewer complications.