Improving clinical outcome in bacteremia

Bacteremia is associated with significant morbidity and mortality. There is wide variation in morbidity and mortality rates according to organism and predisposing conditions. Additionally, prompt administration of appropriate antimicrobial agents is associated with a decrease in mortality. Unfortunately, many bacteremic patients receive inappropriate or no antibiotics. Infectious disease consultation can decrease the number of patients receiving inappropriate initial therapy. 'Quality standard for the treatment of bacteremia' (Gross et al., 1994, Infection Control and Hospital Epidemiology 15, 189-192) is a consensus paper; its purpose is to 'improve the treatment of hospitalized patients with documented bacteremia by ensuring that they receive an antibiotic appropriate in light of the blood-culture susceptibility of the pathogen isolated.' A programme to assess the treatment of bacteremia can improve the quality of care with a modest commitment of additional resources. Many of the activities could be performed by a pharmacist, infection control practitioner, or pathologist. However, physician-to-physician communications are most likely to be successful. This programme should be considered a component of a hospital's quality-improvement programme; either the hospital quality assurance or infection control committee could be responsible for the programme. We encourage adoption of the standard, and recommend prospective monitoring to include the choice of empiric antimicrobial agents.