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

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 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 (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 ( = .67). Other comparisons were numerically different but not significant: repeat blood culture (98.8% vs 87.5%; = .17), echocardiography (70.2% vs 50%; = .26), CVC removal (91.7% vs 83.3%; = .45), and initial echinocandin treatment (67.9% vs 50%; = .44). IDC resulted in more ophthalmology examinations (67.9% vs 12.5%; = .0035). All patients received antifungal therapy. Antimicrobial stewardship recommendations were performed in 19 episodes (20.7%). The median EQUAL score with CVC was higher with IDC (16 vs 11; = .001) but not in episodes without CVC (12 vs 11.5; = .81).

CONCLUSIONS

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