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Early decisions regarding treatment for patients with bloodstream infections (BSIs) made by properly trained and accredited clinicians with timely access to the most up-to-date laboratory data is essential, writes Alida Fe Talento, MD, of the Department of Microbiology at Beaumont Hospital in Dublin, Ireland, in a commentary in the September issue of Infection Control and Hospital Epidemiology. Talento says the United States should consider adopting a multifacted approach that has worked well in European countries.
Talento writes, "In our hospital, as in many others, the clinical microbiologist is informed by the laboratory scientist when a potential pathogen is isolated from a sterile site. This occurs 24 hours per day. The clinical microbiologist liaises with the attending physician, offering therapeutic, additional diagnostic, and infection control advice. All patients are reviewed clinically and fully assessed by the clinical microbiology service, which consists of a consultant microbiologist and a medically qualified microbiology trainee; entries are made in the patient notes recommending further management. In this model, antibiotic and other therapeutic recommendations and related patient care issues, additional scientific examination of the specimen, additional diagnostic evaluation, microbiology workload issues, antimicrobial stewardship, infection control, and hospital epidemiology requirements are all coordinated by a single trained individual as part of a multidisciplinary team. This broad, multifaceted approach has a high level of support and uptake from clinical colleagues and may account for the higher level of appropriate treatment of patients with MRSA BSI."
Talento refers to a study by Herzke et al. about empirical antimicrobial therapy for BSI due to methicillin-resistant Staphylococcus aureus (MRSA), in which 51.8 percent of the patients with MRSA BSI received appropriate empirical therapy. Talento says that at her hospital, 91 percent of patients with MRSA BSI received appropriate treatment in the first 24 hours after the organism was identified in blood culture. Talento suggests the reasons for the disparity "may be the sometimes segregated nature of infection services in some US hospitals, where microbiology laboratories are often managed by scientists or managers; where patient consultation and antibiotic advice may be provided by infectious diseases physicians, who may not have timely information regarding laboratory results; where surveillance of hospitalacquired infection can be undertaken by a hospital epidemiologist; where infection prevention is often the remit of infection control practitioners; and where liaisons between the microbiology laboratory and the attending physician are sometimes undertaken by clinical pharmacists. In many European countries and elsewhere, these roles are all undertaken by a physician, usually a medically qualified clinical microbiologist. In Ireland, clinical microbiologists usually undergo initial postgraduate training in general internal medicine, surgery, or pediatrics and then undertake five years of higher specialist training in all aspects of infection, culminating in the membership examination of the UK Royal College of Pathologists."
Reference: Talento AF. An Integrated Clinical Microbiology Service Ensures Optimal Early Empirical Antimicrobial Therapy for MethicillinResistant Staphylococcus aureus Bloodstream Infection. Infect Control Hosp Epidemiol. 2010;31:981-983.