Skip to main content Accessibility help
×
Home

Improved Clinical Outcome of Patients With Candida Bloodstream Infections Through Direct Consultation by Infectious Diseases Physicians in a Japanese University Hospital

  • Shunji Takakura (a1) (a2), Naoko Fujihara (a1) (a2), Takashi Saito (a1) (a2), Terumi Kimoto (a1) (a2), Yutaka Ito (a1) (a3), Yoshitsugu Iinuma (a1) (a2) and Satoshi Ichiyama (a1) (a2)...

Abstract

Objective.

To examine whether intervention by infectious diseases physicians (IDPs) in the treatment decisions that emphasize adequate antifungal treatment and early removal of central venous catheter for patients with Candida bloodstream infection (BSI) improves prognosis.

Design.

Retrospective cohort study of patients with Candida BSI, comparing the prognosis of patients before and after the start of the intervention.

Setting.

A 1,240-bed, tertiary care university hospital.

Patients.

Forty patients with Candida BSI during a 2-year period, from January 2001 to December 2002, were included in the study Twenty-three patients in the first year after the start of intervention by IDPs (intervention group) were compared with 17 patients in the first year before the start of the IDP intervention (baseline group).

Interventions.

In January 2002, a total of 5 IDPs at Kyoto University Hospital gave unsolicited recommendations on antifungal treatment and advised all physicians treating inpatients who had Candida BSI to remove the central venous catheter.

Results.

No significant difference was seen between the 2 groups in patients' clinical background, species, and fluconazole susceptibility of the causative organisms. The 30-day survival rate was significantly better in the intervention group (18 [78%] of 23 patients) than in the baseline group (7 [44%] of 16 patients; P = .04 by Fisher's exact test). More patients in the intervention group than in the baseline group received appropriate antifungal therapy (81% vs 50%) and had their central venous catheter removed at an appropriate time (95% vs 81%)

Conclusion.

The introduction of an active system of IDP consultation for every case of Candida BSI in our hospital substantially improved patient outcomes.

Copyright

Corresponding author

Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, 6068507, Japan, (stakakr@kuhp.kyoto-u.ac.jp)

References

Hide All
1.John, JF Jr, Fishman, NO. Programmatic role of the infectious diseases physician in controlling antimicrobial costs in the hospital. Clin Infect Dis 1997; 24:471485.
2.Yinnon, AM. Whither infectious diseases consultations? Analysis of 14,005 consultations from a 5-year period. Clin Infect Dis 2001; 33:16611667.
3.Gums, JG, Yancey, RW Jr, Hamilton, CA, et al. A randomized, prospective study measuring outcomes after antibiotic therapy intervention by a multidisciplinary consult team. Pharmacotherapy 1999; 19:13691377.
4.Fox, BC, Imrey, PB, Voights, MB, et al. Infectious disease consultation and microbiologic surveillance for intensive care unit trauma patients: a pilot study. Clin Infect Dis 2001; 33:19811989.
5.Lobati, F, Herndon, B, Bamberger, D. Osteomyelitis: etiology, diagnosis, treatment and outcome in a public versus a private institution. Infection 2001; 29:333336.
6.Fowler, VG Jr, Sanders, LL, Sexton, DJ, et al. Outcome of Staphylococcus aureus bacteremia according to compliance with recommendations of infectious diseases specialists: experience with 244 patients. Clin Infect Dis 1998; 27:478486.
7.Wey, SB, Mori, M, Pfaller, MA, et al. Hospital-acquired candidemia: the attributable mortality and excess length of stay. Arch Intern Med 1988; 148:26422645.
8.Gudlaugsson, O, Gillespie, S, Lee, K, et al. Attributable mortality of nosocomial candidemia, revisited. Clin Infect Dis 2003; 37:11721177.
9.Fridkin, SK, Jarvis, WR. Epidemiology of nosocomial fungal infections. Clin Microbiol Rev 1996; 9:499511.
10.Hung, CC, Chen, YC, Chang, SC, et al. Nosocomial candidemia in a university hospital in Taiwan. J Formosan Med Assoc 1996; 95:1928.
11.Nucci, M, Colombo, AL, Silveira, F, et al. Risk factors for death in patients with candidemia. Infect Control Hosp Epidemiol 1998; 19:846850.
12.Nguyen, MH, Peacock, JE Jr, Tanner, DC, et al. Therapeutic approaches in patients with candidemia: evaluation in a multicenter, prospective, observational study. Arch Intern Med 1995; 155:24292935.
13.Luzzati, R, Amalfitano, G, Lazzarini, L, et al. Nosocomial candidemia in non-neutropenic patients at an Italian tertiary care hospital. Eur J Clin Microbiol Infect Dis 2000; 19:602607.
14.Nucci, M, Anaissie, E. Should vascular catheters be removed from all patients with candidemia? An evidence-based review. Clin Infect Dis 2002; 34:591599.
15.Takakura, S, Fujihara, N, Saito, T, et al. Clinical factors associated with fluconazole resistance and short-term survival in patients with Candida bloodstream infection. Eur J Clin Microbiol Infect Dis 2004; 23:380388.
16.Natsch, S, Steeghs, MH, Hekster, YA, et al. Use of fluconazole in daily practice: still room for improvement. J Antimicrob Chemother 2001; 48: 303310.
17.Rex, JH, Walsh, TJ, Sobel, JD, et al. Practice guidelines for the treatment of candidiasis. Clin Infect Dis 2000; 30:662678.
18.Gilbert, DN, Moellering, RC Jr, Sande, MA, eds. The Sanford Guide to Antimicrobial Therapy. 31st ed. Hyde Park, VT: Antimicrobial Therapy; 2001.
19.Warren, NG, Hazen, KC. Candida, Cryptococcus, and other yeasts of medical importance. In: Murray, PR, Baron, EJ, Pfaller, MA, Tenover, FC, Yolken, RH, eds. Manual of Clinical Microbiology. 7th ed. Washington, DC: ASM Press; 1999:11841199.
20.National Committee for Clinical Laboratory Standards. Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts: Approved Standard M27-A2. Wayne, PA: NCCLS; 2002.

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed