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JAC Advance Access published online on December 30, 2005
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dki463
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Received September 27, 2005
Revised November 23, 2005
Accepted November 29, 2005

Antimicrobial practice

Adjustment of antibiotic treatment according to the results of blood cultures leads to decreased antibiotic use and costs

Dag Berild 1 *, Atefeh Mohseni 1, Lien My Diep 2, Mogens Jensenius 1, and Signe Holta Ringertz 3

1 Department of Internal Medicine, Aker University Hospital, N-0514 Oslo, Norway
2 Research Centre, Aker University Hospital, N-0514 Oslo, Norway
3 Department of Microbiology, Aker University Hospital, N-0514 Oslo, Norway

* To whom correspondence should be addressed.
Dag Berild, E-mail: dag.berild{at}medisin.uio.no


  Abstract

Introduction: To avoid the use of unnecessary broad-spectrum antibiotics, empirical therapy of bacteraemia should be adjusted according to the results of blood cultures.

Objectives: To investigate whether the results of blood cultures led to changes in antibiotic use and costs in a tertiary-care university hospital in Norway.

Methods: Medical records from all patients with positive blood cultures in 2001 were analysed retrospectively. Factors predisposing to infections, results of blood cultures, antibiotic use and outcome were recorded. The influence of blood culture results on antibiotic treatment and costs were analysed.

Results: The antibiotic use in 226 episodes of bacteraemia in 214 patients was analysed. According to the guidelines empirical antibiotic treatment should be adjusted in 166 episodes. Antibiotic use was adjusted in 146 (88%) of these 166 episodes, which led to a narrowing of therapy in 118 (80%) episodes. Compared with empirical therapy there was a 22% reduction in the number of antibiotics. Adjustment of therapy was more often performed in Gram-negative bacteraemia and polymicrobial cultures than in Gram-positive bacteraemia. In bacteraemia caused by ampicillin-resistant Escherichia coli, ampicillin was mostly replaced by ciprofloxacin. The cost for 7 days adjusted therapy in 146 episodes was E19 800 (23%) less than for 7 days of empirical therapy.

Conclusions: Adjustment of antibiotic therapy according to the results of blood cultures led to a reduction in the number of antibiotics and a narrowing of antibiotic therapy. The costs for antibiotics decreased.

Keywords: bacteraemia; septicaemia; resistance; guidelines; therapy.
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