Impact of Infectious Diseases Specialists and Microbiological Data on the Appropriateness of Antimicrobial Therapy for Bacteremia

Abstract

Antimicrobial therapy for 428 episodes of bacteremia in an 850-bed university hospital was prospectively evaluated for 1 year to measure the impact of two factors--blood culture results and the therapy chosen by infectious diseases 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 proportion reached 78% for the episodes treated by IDSs, compared with 54% for the others (P < .001). After availability of blood culture results, the proportion of appropriate treatments increased to 94%, with 97% for IDS-treated patients and 89% for other patients (P = .008). IDSs more frequently shifted to oral antibiotics and used fewer broad-spectrum drugs. This study underlines the impact of blood culture results and of IDSs on the prescription of appropriate treatment for bacteremia and on the better use of antimicrobial drugs.

Pharmacokinetic/pharmacodynamic (PK/PD) considerations in the management of Gram-positive bacteraemia

“…Continuous infusion might make treatment monitoring and adjustment easier and cheaper because vancomycin concentrations in serum are less variable and more sustained [30]. In a prospective multicenter randomized trial comparing critically ill patients with severe meticillin-resistant staphylococcal infections, continuous infusion of vancomycin resulted in therapeutic concentrations being achieved more quickly, less AUC variability between patients, fewer samples required to monitor treatment, and reduced 10-day antibiotic cost; clinical efficacy and safety were comparable to the intermittent infusion schedule [31].…”

Epidemiology of Intensive Care Unit Infections and Impact of Infectious Disease Consultants in Managing Resistant Infections

“…Another factor that has been shown in western studies to improve the quality of antibiotic prescription and de-escalation was consultation by an Infectious Disease (ID) specialist (Byl et al, 1999;Fluckiger et al, 2000). There are no studies that have analyzed the impact of ID consultations on empiric antibiotic selection and de-escalation practices in the Indian ICU setting.…”

Optimización del tratamiento antibiótico mediante la participación de expertos en antibióticos

“…El acercamiento hacia el médico prescriptor de otro compañero (un infectólogo habitualmente) sugiriendo un cambio en el antibiótico junto a un implicación clínica directa en el caso puede mejorar los resultados (2). El experto en antibióticos permite aportar una mayor sensibilidad y seguridad en la interpretación de los cultivos y resultados del antibiograma, así como una mayor seguridad en el empleo por vía oral de los antibióticos, gracias al mejor conocimiento (13) de aspectos farmacocinéticos y farmacodinámicos de los mismos (14). En nuestra experiencia, al igual que en otros trabajos previos, el acercamiento hacia el médico prescriptor de un modo no impositivo, favoreciendo la responsabilidad compartida sobre la evolución del enfermo, ha tenido una acogida muy favorable (2,3,13,15).…”

“…Este tipo de actuación es una de las razones de la existencia de las unidades de infectología en los hospitales generales (12)(13)(14)16,17). Nuestra intervención no se asoció a ningún dato que haga sospechar peor evolución de los pacientes, ya que ni la mortalidad ni la incidencia de de infecciones por bacterias resistentes durante el periodo de estudio aumentaron significativamente.…”

“…Utilizar la vía oral desde el principio es posible con algunos fármacos con excelente biobisponibilidad como clindamicina, metronidazol o fluoroquinolonas (2,14,19,20).…”