Hostname: page-component-848d4c4894-cjp7w Total loading time: 0 Render date: 2024-06-29T20:31:49.316Z Has data issue: false hasContentIssue false
  • English
  • Français

The interplay of infectious diseases consultation and antimicrobial stewardship in candidemia outcomes: A retrospective cohort study from 2016 to 2019

Published online by Cambridge University Press:  09 September 2022

Jonathan H. Ryder Open the ORCID record for Jonathan H. Ryder [Opens in a new window] ,
Trevor C. Van Schooneveld Open the ORCID record for Trevor C. Van Schooneveld [Opens in a new window] ,
Elizabeth Lyden ,
Razan El Ramahi  and
Erica J. Stohs Open the ORCID record for Erica J. Stohs [Opens in a new window]
Jonathan H. Ryder*
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
Trevor C. Van Schooneveld
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
Elizabeth Lyden
Affiliation:
Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
Razan El Ramahi
Affiliation:
Infectious Disease Doctors, PA, Fort Worth, Texas
Erica J. Stohs
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
*
Author for correspondence: Jonathan H. Ryder, E-mail: jonathan.ryder@unmc.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To evaluate the need for mandatory infectious diseases consultation (IDC) for candidemia in the setting of antimicrobial stewardship guidance.

Design:

Retrospective cohort study from January 2016 to December 2019.

Setting:

Academic quaternary-care referral center.

Patients:

All episodes of candidemia in adults (n = 92), excluding concurrent bacterial infection or death or hospice care within 48 hours.

Methods:

Primary outcome was all-cause 30-day mortality. Secondary outcomes included guideline-adherence and treatment choice. Guideline-adherence was assessed with the EQUAL Candida score.

Results:

Of 186 episodes of candidemia, 92 episodes in 88 patients were included. Central venous catheters (CVCs) were present in 66 episodes (71.7%) and were the most common infection source (N = 38, 41.3%). The most frequently isolated species was Candida glabrata (40 of 94, 42.6%). IDC was performed in 84 (91.3%) of 92 candidemia episodes. Mortality rates were 20.8% (16 of 77) in the IDC group versus 25% (2 of 8) in the no-IDC group (P = .67). Other comparisons were numerically different but not significant: repeat blood culture (98.8% vs 87.5%; P = .17), echocardiography (70.2% vs 50%; P = .26), CVC removal (91.7% vs 83.3%; P = .45), and initial echinocandin treatment (67.9% vs 50%; P = .44). IDC resulted in more ophthalmology examinations (67.9% vs 12.5%; P = .0035). All patients received antifungal therapy. Antimicrobial stewardship recommendations were performed in 19 episodes (20.7%). The median EQUAL Candida score with CVC was higher with IDC (16 vs 11; P = .001) but not in episodes without CVC (12 vs 11.5; P = .81).

Conclusions:

In the setting of an active antimicrobial stewardship program and high consultation rates, mandatory IDC may not be warranted for candidemia.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 7 , July 2023 , pp. 1102 - 1107
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION: These data were presented as a poster at IDWeek 2021 on September 29–October 3, 2021, held virtually. The abstract was previously published: Ryder JH, Van Schooneveld TC, Stohs EJ. Is there value of infectious diseases consultation in candidemia? A single-center retrospective review from 2016–2019. Open Forum Infect Dis 2021;8 supplement 1:S584–S585.

References

Magill, SS, O’Leary, E, Janelle, SJ, et al. Changes in prevalence of health care–associated infections in US hospitals. N Engl J Med 2018;379:1732–1744.CrossRefGoogle Scholar
Tsay, SV, Mu, Y, Williams, S, et al. Burden of candidemia in the United States, 2017. Clin Infect Dis 2020;71:e449–e453.Google ScholarPubMed
Kobayashi, T, Marra, AR, Schweizer, ML, et al. Impact of infectious disease consultation in patients with candidemia: a retrospective study, systematic literature review, and meta-analysis. Open Forum Infect Dis 2020;7:ofaa270.CrossRefGoogle ScholarPubMed
Patel, M, Kunz, DF, Trivedi, VM, Jones, MG, Moser, SA, Baddley, JW. Initial management of candidemia at an academic medical center: evaluation of the IDSA guidelines. Diagn Microbiol Infect Dis 2005;52:29–34.CrossRefGoogle ScholarPubMed
Mellinghoff, SC, Hoenigl, M, Koehler, P, et al. EQUAL Candida score: an ECMM score derived from current guidelines to measure quality of clinical candidaemia management. Mycoses 2018;61:326–330.CrossRefGoogle ScholarPubMed
Bal, AM. European confederation of medical mycology quality of clinical candidaemia management score: a review of the points based best practice recommendations. Mycoses 2021;64:123–131.CrossRefGoogle Scholar
Cornely, OA, Bassetti, M, Calandra, T, et al. ESCMID guideline for the diagnosis and management of Candida diseases 2012: nonneutropenic adult patients. Clin Microbiol Infect 2012;18:19–37.CrossRefGoogle Scholar
Pappas, PG, Kauffman, CA, Andes, DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis 2016;62:e1–e50.CrossRefGoogle ScholarPubMed
Huang, H-Y, Lu, P-L, Wang, Y-L, Chen, T-C, Chang, K, Lin, S-Y. Usefulness of EQUAL Candida score for predicting outcomes in patients with candidaemia: a retrospective cohort study. Clin Microbiol Infect 2020;26:1501–1506.CrossRefGoogle ScholarPubMed
Kim, JH, Suh, JW, Kim, MJ. Epidemiological trends of candidemia and the impact of adherence to the candidemia guideline: six-year single-center experience. J Fungi 2021;7:275.CrossRefGoogle Scholar
Bal, AM, Palchaudhuri, M. Candidaemia in the elderly: epidemiology, management and adherence to the European Confederation of Medical Mycology quality indicators. Mycoses 2020;63:892–899.CrossRefGoogle Scholar
Pinto-Magalhães, S, Martins, A, Lacerda, S, et al. Candidemia in a Portuguese tertiary-care hospital: analysis of a 2-year period. J Mycol Med 2019;29:320–324.CrossRefGoogle Scholar
Calderón-Parra, J, Herraiz-Jiménez, J, Ramos-Martínez, A, et al. A retrospective validation of different scores of guideline adherence and infectious diseases consultation on candidaemia: the higher, the better. Mycoses 2021;64:742–747.CrossRefGoogle ScholarPubMed
Antworth, A, Collins, CD, Kunapuli, A, et al. Impact of an antimicrobial stewardship program comprehensive care bundle on management of candidemia. Pharmacotherapy 2013;33:137–143.CrossRefGoogle ScholarPubMed
Reed, EE, West, JE, Keating, EA, et al. Improving the management of candidemia through antimicrobial stewardship interventions. Diagn Microbiol Infect Dis 2014;78:157–161.CrossRefGoogle ScholarPubMed
Murakami, M, Komatsu, H, Sugiyama, M, et al. Antimicrobial stewardship without infectious disease physician for patients with candidemia: a before-and-after study. J Gen Fam Med 2018;19:82–89.CrossRefGoogle ScholarPubMed
Pettit, NN, Han, Z, Nguyen, CT, et al. Antimicrobial stewardship review of automated candidemia alerts using the epic stewardship module improves bundle-of-care adherence. Open Forum Infect Dis 2019;6:ofz412.CrossRefGoogle ScholarPubMed
Lee, RA, Zurko, JC, Camins, BC, et al. Impact of infectious disease consultation on clinical management and mortality in patients with candidemia. Clin Infect Dis 2019;68:1585–1587.CrossRefGoogle ScholarPubMed
Hermsen, ED, Njoku, J, Pfiifer, R, Van Schooneveld, T. The Nebraska Medical Center guidelines for management of invasive candidiasis. University of Nebraska Medical Center website. https://www.unmc.edu/intmed/_documents/id/asp/clinicpath-candidiasis_pathway_tnmcmar2011.pdf. Published 2011. Accessed July 15, 2022.Google Scholar
Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.CrossRefGoogle ScholarPubMed
Mejia-Chew, C, O’Halloran, JA, Olsen, MA, et al. Effect of infectious disease consultation on mortality and treatment of patients with candida bloodstream infections: a retrospective cohort study. Lancet Infect Dis 2019;19:1336–1344.CrossRefGoogle ScholarPubMed
Ishikane, M, Hayakawa, K, Kutsuna, S, Takeshita, N, Ohmagari, N. The impact of infectious disease consultation in candidemia in a tertiary-care hospital in Japan over 12 years. PLoS One 2019;14:e0215996.CrossRefGoogle Scholar
Chesdachai, S, Kline, S, Helmin, D, Rajasingham, R. The effect of infectious diseases consultation on mortality in hospitalized patients with methicillin-resistant Staphylococcus aureus, Candida, and Pseudomonas bloodstream infections. Open Forum Infect Dis 2020;7:ofaa010.CrossRefGoogle ScholarPubMed
Mazi, PB, Olsen, MA, Stwalley, D, et al. Attributable mortality of Candida bloodstream infections in the modern era: a propensity score analysis. Clin Infect Dis 2022:ciac004.CrossRefGoogle Scholar
Andes, DR, Safdar, N, Baddley, JW, et al. Impact of treatment strategy on outcomes in patients with candidemia and other forms of invasive candidiasis: a patient-level quantitative review of randomized trials. Clin Infect Dis 2012;54:1110–1122.CrossRefGoogle ScholarPubMed
Breazzano, MP, Bond, JB, Bearelly, S, et al. American Academy of Ophthalmology recommendations on screening for endogenous Candida endophthalmitis. Ophthalmology 2022;129:73–76.CrossRefGoogle ScholarPubMed
Forsblom, E, Ruotsalainen, E, Ollgren, J, Järvinen, A. Telephone consultation cannot replace bedside infectious disease consultation in the management of Staphylococcus aureus bacteremia. Clin Infect Dis 2013;56:527–535.CrossRefGoogle ScholarPubMed
Supplementary material: File

Ryder et al. supplementary material

Ryder et al. supplementary material

Download Ryder et al. supplementary material(File)
File 29.1 KB