Bloodstream infections: A trial of the impact of different methods of reporting positive blood culture results

Abstract

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 €580.63, €537.98, and €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.