The following article requires a subscription:



(Format: HTML, PDF)

Background: The impact of how positive blood culture results are reported on the evolution bloodstream infections (BSIs) has not been assessed.

Methods: We randomly assigned patients with BSIs into 3 groups: group A (for which physicians received a conventional report), group B (for which physicians received a conventional report and a written alert on the chart with clinical advice), and group C (for which physicians received the above plus oral clinical advice). The adequacy of therapy before and after receipt of the different types of information was assessed.

Results: Overall, 297 episodes (109 in group A, 99 in group B, and 89 in group C) were studied. Patients who received inadequate treatment before receiving microbiological information had a longer mean ( /-SD) hospital stay (27.2 /- 32.4 vs. 19.4 /- 15.8 days; P = .017), a higher mean risk of Clostridium difficile-associated diarrhea (8.3% vs. 1.9%; P = .013), a higher mean overall mortality rate (30.8% vs. 19.4%; P = .025), and a higher mean risk of infection-related mortality (23.3% vs. 13.6%; P = .031). After receipt of microbiological reports, recommendations for changes in therapy were issued for patients in groups B (52.3%) and C (53.1%). For groups A, B, and C, the proportions of days on which adequate treatment was received were 66.3%, 92.1%, and 91.2% (P < .001); the mean numbers of defined daily doses of appropriate antibiotic therapy were 16.4, 22.2, and 20.7 (P = .003); the mean durations of hospital stay were 19.8, 23.6, and 24.1 days (P = .761); and the mortality rates during the late period were 12.9%, 15.6%, and 11% (P = .670), respectively. The mean costs of antimicrobials per episode in groups A, B, and C were [Euro sign]580.63, [Euro sign]537.98, and [Euro sign]434.53 (US$707.85, US$699.73, and US$529.73, respectively).

Conclusions: Written- or oral-alert reports with clinical advice should complement traditional microbiological reports for patients with BSIs.

(C) Copyright Oxford University Press 2004.