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

Published online by Cambridge University Press:  21 June 2016

Shunji Takakura
Affiliation:
Departments of Infection Control and Prevention, Kyoto University Graduate School of Medicine, Kyoto, Japan Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
Naoko Fujihara
Affiliation:
Departments of Infection Control and Prevention, Kyoto University Graduate School of Medicine, Kyoto, Japan Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
Takashi Saito
Affiliation:
Departments of Infection Control and Prevention, Kyoto University Graduate School of Medicine, Kyoto, Japan Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
Terumi Kimoto
Affiliation:
Departments of Infection Control and Prevention, Kyoto University Graduate School of Medicine, Kyoto, Japan Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
Yutaka Ito
Affiliation:
Departments of Infection Control and Prevention, Kyoto University Graduate School of Medicine, Kyoto, Japan Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
Yoshitsugu Iinuma
Affiliation:
Departments of Infection Control and Prevention, Kyoto University Graduate School of Medicine, Kyoto, Japan Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
Satoshi Ichiyama
Affiliation:
Departments of Infection Control and Prevention, Kyoto University Graduate School of Medicine, Kyoto, Japan Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
Corresponding

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.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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