Parameters:
(1) time interval between onset of bloodstream infection and initiation of therapy
(2) selection of initial therapy based on organism susceptibility
(3) dose and route of administration for the antimicrobials selected
(4) cognitive errors
Appropriate therapy - all of the following:
(1) antimicrobial therapy started within 24 hours of onset
(2) use of at least one antibiotic that was active against the causative organisms on in vitro susceptibility testing
(3) dose and route of administration conform to current medical standards
(4) no cognitive errors (see below)
Inappropriate therapy - one or more of the following:
(1) antimicrobial therapy not started within 24 hours of onset
(2) causative organisms resistant on in vitro susceptibility to all of the antibiotics used
(3) dose and route of administration do not conform to current medical standards
(4) a cognitive error
(4a) failing to treat a known pathogen
(4b) use of aminoglycoside monotherapy for bacteremia with Pseudomonas aeruginosa
where:
• The time interval was specified in 2 ways - (a) within 24 hours after acquisition of a blood culture sample, or (b) within 24 hours of bacteremia onset. The latter was used in the implementation.
There is always a risk that the initial antibiotics chosen are inappropriate, especially if the isolated are antibiotic-resistant. Therefore it is important to closely monitor the results of cultures and to make quick adjustments as needed.
