Department of Pharmacy, University of Michigan Hospital and Health Systems, Ann Arbor, MI 48109, USA.
Pharmacotherapy. 2013 Feb;33(2):137-43. doi: 10.1002/phar.1186. Epub 2013 Jan 25.
To analyze the impact of a comprehensive care bundle directed by an antimicrobial stewardship team (AST) on the management of candidemia.
Single-center, quasi-experimental study.
A 930-bed academic hospital.
Seventy-eight patients with candidemia were evaluated; 41 patients received the candidemia care bundle (AST group), and 37 did not (historical control group).
A candidemia care bundle was developed by an interdisciplinary AST, incorporating key elements from the Infectious Diseases Society of America's Clinical Practice Guidelines for the Management of Candidemia. The AST made prospective recommendations in accordance with the care bundle. Bundle elements were utilization of appropriate antifungal agents with appropriate duration of use, removal of intravenous catheters, repeat blood cultures, monitoring of time until clearance of candidemia, and performance of ophthalmologic examinations. Compliance with all candidemia care bundle elements was significantly higher in the AST group versus the control group (78.0% vs 40.5%, p=0.0016). Implementation of the care bundle significantly improved rates of ophthalmologic examination (97.6% vs 75.7%, p=0.0108), selection of appropriate antifungal therapy (100% vs 86.5%, p=0.0488), and compliance with an appropriate duration of therapy (97.6% vs 67.7%, p=0.0012). In addition, the AST group had fewer excess total days of therapy beyond the recommended duration than the control group (5 vs 83 total antifungal days). Length of hospitalization (20 vs 21 days, p=0.9184), time until clearance of candidemia (3 vs 3 days p=0.610), rate of persistent candidemia (22% vs 40.5%, p=0.126), and rate of recurrent candidemia (4.9% vs 5.4%, p=0.916) were similar in the AST group versus the control group.
A comprehensive candidemia care bundle directed by our institution's AST improved the management of patients with candidemia. We encourage further exploration into the use of care bundles by ASTs as part of their multifaceted approach to promoting appropriate antimicrobial utilization and optimizing the management of patients with infectious diseases.
分析由抗菌药物管理团队（AST）指导的综合护理包对念珠菌血症管理的影响。
单中心、准实验研究。
一家拥有 930 张床位的学术医院。
评估了 78 例念珠菌血症患者；41 例患者接受了念珠菌血症护理包（AST 组），37 例患者未接受（历史对照组）。
AST 制定了一个念珠菌血症护理包，纳入了美国传染病学会念珠菌血症临床实践指南的关键要素。AST 根据护理包进行了前瞻性建议。护理包的元素包括使用适当的抗真菌药物和适当的使用时间、去除静脉导管、重复血培养、监测清除念珠菌血症的时间以及进行眼科检查。AST 组与对照组相比，所有念珠菌血症护理包元素的依从性显著更高（78.0%对 40.5%，p=0.0016）。护理包的实施显著提高了眼科检查率（97.6%对 75.7%，p=0.0108）、选择适当的抗真菌治疗率（100%对 86.5%，p=0.0488）和遵守适当治疗时间的比率（97.6%对 67.7%，p=0.0012）。此外，AST 组比对照组的总治疗天数超过推荐时间的天数更少（5 天对 83 天）。住院时间（20 天对 21 天，p=0.9184）、清除念珠菌血症的时间（3 天对 3 天，p=0.610）、持续念珠菌血症的发生率（22%对 40.5%，p=0.126）和复发性念珠菌血症的发生率（4.9%对 5.4%，p=0.916）在 AST 组与对照组之间相似。
由我们机构的 AST 指导的综合念珠菌血症护理包改善了念珠菌血症患者的管理。我们鼓励进一步探索 AST 使用护理包作为其多方面方法的一部分，以促进适当的抗菌药物使用和优化传染病患者的管理。
