Implementation of consensus guidelines for the follow-up of positive blood cultures

Assess the effect and use of resources associated with implementation of a program for the systematic follow-up of positive blood cultures.

Prospective epidemiologic study.

Tertiary-care military medical center.

All positive blood cultures (BC) were reported via E-mail to an infectious disease specialist as soon as growth was noted. This individual reviewed all Gram stains, clinical data, and antibiotic information on these patients.

From June 26, 1994, through January 25, 1995, there were 3,121 BCs drawn, of which 199 (6.4%) were positive from 145 episodes. Sixty-three episodes involved probable contaminants, and 82 episodes were considered true bacteremias. Six patients with true bacteremia died, two were transferred, and three were discharged within 24 hours of drawing the positive BC. Of the remaining 71 true bacteremias, 9 patients were on inadequate empiric therapy, as judged by the final organism susceptibilities. 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 final identification and susceptibilities).

This program has improved the quality of care at Keesler Medical Center at the cost of one additional hour of consultant time per week.