Nosocomial bacteremia: impact of empirical antimicrobial treatment on the patients' outcome.

OBJECTIVE

To determine the impact on patients' outcome of clinical effectiveness of empirical antimicrobial treatment of nosocomial bacteremia.

SETTING

904-bed hospital, comprising acute care wards, rehabilitation and intermediate care wards and long-term care wards, that provides care primarily for aged (880 beds); design: prospective cohort analysis to access the evidence regarding the effectiveness of empirical antimicrobial treatment in patients with nosocomial bacteremia, when the Gram stain result was communicated to the physician; data collection: data collected concerned patients' characteristics at the early bacteremia, microbiology, antimicrobial treatment and patients' outcome within 30 days; analysis: patients with clinical signs of bacteremia after the Gram stain result were compared with those without symptoms, in univariate analysis.

RESULTS

Significant differences were not found for age, sex, underlying diseases, comorbidities, hospitalization wards, sources of bacteremia, microorganisms or patients' outcome. However, antimicrobial therapies were more often changed in symptomatic patients after the announcement of the Gram stain result (RR = 1.87; [1.03-3.37]; p = 0.04).

CONCLUSION

This study supports the notion that the outcomes for patients are similar whether patients have symptoms or not when the Gram stain result of the first positive blood culture is communicated to the clinician.