Usefulness of clinical decision support with initial information of positive blood cultures provided by a microbiology laboratory

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  • OKAWA Hironaga
    Department of Clinical Laboratory, Aichi Koseiren Kainan Hospital
  • MOROTO Akiyo
    Department of Clinical Laboratory, Aichi Koseiren Kainan Hospital
  • YAMAMOTO Yukie
    Department of Clinical Laboratory, Aichi Koseiren Kainan Hospital
  • ITO Kaede
    Department of Clinical Laboratory, Aichi Koseiren Kainan Hospital
  • TERASAWA Keisuke
    Department of Clinical Laboratory, Aichi Koseiren Kainan Hospital
  • NAKANE Kazumasa
    Department of Clinical Laboratory, Aichi Koseiren Kainan Hospital
  • MIYATA Eizo
    Department of Laboratory Diagnosis, Aichi Koseiren Kainan Hospital
  • SOUDA Masahiko
    Department of Clinical Laboratory, Aichi Koseiren Kainan Hospital

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Other Title
  • 微生物検査室が発信する血液培養陽性初期情報の有用性と診療支援効果

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<p>We investigated the usefulness of clinical decision support with the initial information of positive blood cultures provided by a microbiology laboratory. Four hundred thirty-seven positive blood cultures from April 2016 to March 2017 were determined as having bacteremia or fungemia. Immediately after detecting positive blood cultures, the laboratory reported the information of putative microorganisms on the basis of Gram staining results as “first report” to clinicians within an hour. The agreement between the first and the final reports was 92.7%. Putative microorganisms were described on medical charts in 328 cases (75.1%), and the alterations of antibiotic therapy were described in 284 cases (65.0%) in accordance with the first report from the laboratory. Clinicians altered their antibiotic therapy in 220 cases (50.3%) over the entire clinical courses, in which the antibiotic therapy in 98 cases (22.4%) was altered after the first report. The frequency of treatment changes for Gram-positive cocci microorganisms was higher after the first reports, whereas that for Gram-negative cocci microorganisms was higher after the final reports. Providing prompt and detailed information can be helpful for antibiotic selection when blood culture results are positive. In this study, we clearly demonstrated that the first reports including putative microorganisms from a microbiology laboratory can lead to a doctor’s appropriate actions such as documentation of medical charts, administration of antibiotics, and alteration of antibiotics. Thus, the prompt reporting of initial blood culture results can contribute to clinical decision-making.</p>

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