Impact of an antifungal stewardship intervention on optimization of candidemia management

Hana Rac; Jamie L Wagner; S Travis King; Katie E Barber; Kayla R Stover

doi:10.1177/2049936117745267

Impact of an antifungal stewardship intervention on optimization of candidemia management

Ther Adv Infect Dis. 2018 Jan;5(1):3-10. doi: 10.1177/2049936117745267. Epub 2017 Dec 10.

Authors

Hana Rac¹, Jamie L Wagner², S Travis King², Katie E Barber², Kayla R Stover³

Affiliations

¹ Department of Pharmacy, University of Mississippi Medical Center, Jackson, MS, USA.
² Department of Pharmacy Practice, School of Pharmacy, University of Mississippi, Jackson, MS, USA.
³ Department of Pharmacy Practice, School of Pharmacy, University of Mississippi; Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.

Abstract

Background: Candidemia represents a leading cause of healthcare-associated bloodstream infections with significant morbidity and mortality. Previous studies have demonstrated that comprehensive care bundles improve candidemia management but are time-consuming.

Objective: To determine the impact of a one-time targeted candidemia intervention on time to initiation of adequate therapy compared to standard of care.

Methods: This Institutional Review Board (IRB)-approved, quasi-experiment evaluated a targeted candidemia intervention involving a single phone call to the primary team providing recommendations for care. Daily follow-up was provided by the infectious diseases (ID) consult service. Two time periods were evaluated: pre-intervention (01 August 2012 to 31 July 2014) and post-intervention (01 October 2014 to 30 September 2016). The primary endpoint was time to adequate antifungal therapy (TTx) in the business hours (6 a.m. to 6 p.m. Monday through Friday) population (BHP). Secondary endpoints were TTx in the total population as well as infection-related length of stay (IF-LOS) and compliance with quality indicators (composite endpoint: ophthalmology (OPH) consult, repeat cultures, and ⩾14 days of adequate therapy).

Results: In all, 117 patients were included (pre-intervention = 50, post-intervention = 67, BHP = 51). TTx decreased from 2 h 57 m to 2 h 12 m (p = 0.094) in the BHP and 3 h 30 m to 2 h 9 m (p = 0.021) in the total population. There was no difference in IF-LOS (p = 0.797), compliance with quality indicators (p = 0.343), or in-hospital mortality (p = 0.761). Post-intervention, there were more ID and OPH consults (p < 0.001).

Conclusions: Our one-time candidemia intervention did not statistically decrease time to adequate therapy in the BHP, but did in the total population. No differences were found for other clinical outcomes, except increases in ID and OPH consults. Further studies are needed to examine whether a one-time intervention is non-inferior to a more comprehensive care bundle.

Keywords: antifungal stewardship; antimicrobial stewardship; candidemia.