抗真菌管理干预对念珠菌血症管理优化的影响。
Impact of an antifungal stewardship intervention on optimization of candidemia management.
作者信息
Rac Hana, Wagner Jamie L, King S Travis, Barber Katie E, Stover Kayla R
机构信息
Department of Pharmacy, University of Mississippi Medical Center, Jackson, MS, USA.
Department of Pharmacy Practice, School of Pharmacy, University of Mississippi, Jackson, MS, USA.
出版信息
Ther Adv Infect Dis. 2018 Jan;5(1):3-10. doi: 10.1177/2049936117745267. Epub 2017 Dec 10.
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 ( = 0.094) in the BHP and 3 h 30 m to 2 h 9 m ( = 0.021) in the total population. There was no difference in IF-LOS ( = 0.797), compliance with quality indicators ( = 0.343), or in-hospital mortality ( = 0.761). Post-intervention, there were more ID and OPH consults ( < 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.
背景
念珠菌血症是医疗相关血流感染的主要原因之一，具有较高的发病率和死亡率。既往研究表明，综合护理方案可改善念珠菌血症的管理，但耗时较长。
目的
与标准治疗相比，确定一次性针对性念珠菌血症干预对开始适当治疗时间的影响。
方法
本研究经机构审查委员会（IRB）批准，为准实验性研究，评估了一项针对性念珠菌血症干预措施，即向主要治疗团队打一个电话提供护理建议。由感染病（ID）咨询服务部门提供每日随访。评估了两个时间段：干预前（2012年8月1日至2014年7月31日）和干预后（2014年10月1日至2016年9月30日）。主要终点是工作日（周一至周五上午6点至下午6点）人群（BHP）开始适当抗真菌治疗的时间（TTx）。次要终点是总人群的TTx以及感染相关住院时间（IF-LOS）和质量指标的依从性（综合终点：眼科（OPH）咨询、重复培养以及至少14天的适当治疗）。
结果
共纳入117例患者（干预前 = 50例，干预后 = 67例，BHP = 51例）。BHP中TTx从2小时57分钟降至2小时12分钟（P = 0.094），总人群中从3小时30分钟降至2小时9分钟（P = 0.021）。IF-LOS（P = 0.797）、质量指标依从性（P = 0.343）或住院死亡率（P = 0.761）无差异。干预后，ID和OPH咨询更多（P < 0.001）。
结论
我们的一次性念珠菌血症干预在BHP中未在统计学上降低开始适当治疗的时间，但在总人群中降低了。除了ID和OPH咨询增加外，其他临床结局未发现差异。需要进一步研究以检验一次性干预是否不劣于更全面的护理方案。
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