Abstract
We evaluated the use of antibiotics for 2 positive blood cultures (BCs) growing coagulase-negative staphylococci and the effect of a mandatory infectious diseases (ID) consultation for vancomycin use on antibiotic continuation. Of 113 patients admitted through the emergency department with 2 positive BCs for coagulase-negative staphylococci, 70 (62%) had systemic inflammatory response syndrome. The same organism was identified in both BCs in 103 patients (91%). Forty-five patients had prosthetic devices, with 93% being intravascular devices. Antibiotics were started in 67 patients (59%), of them 88% received vancomycin. Infectious diseases consult was sought in 74 cases (65%). The ID consultant recommended no antibiotics or discontinuation in 36 patients (49%). Infectious diseases consult continued antibiotics in 30 patients (88%) with prosthetic device, compared with 8 (20%) without prosthetic device (P < 0.001). We conclude that ID consultation may lead to a reduction in inappropriate utilization of vancomycin in the presence of a high prevalence of BC contamination.
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