Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
Infect Control Hosp Epidemiol. 2023 Jul;44(7):1102-1107. doi: 10.1017/ice.2022.209. Epub 2022 Sep 9.
To evaluate the need for mandatory infectious diseases consultation (IDC) for candidemia in the setting of antimicrobial stewardship guidance.
Retrospective cohort study from January 2016 to December 2019.
Academic quaternary-care referral center.
All episodes of candidemia in adults (n = 92), excluding concurrent bacterial infection or death or hospice care within 48 hours.
Primary outcome was all-cause 30-day mortality. Secondary outcomes included guideline-adherence and treatment choice. Guideline-adherence was assessed with the EQUAL score.
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).
In the setting of an active antimicrobial stewardship program and high consultation rates, mandatory IDC may not be warranted for candidemia.
评估在抗菌药物管理指导下，强制性传染病咨询（IDC）对念珠菌血症的需求。
2016 年 1 月至 2019 年 12 月的回顾性队列研究。
学术四级保健转诊中心。
所有成人念珠菌血症患者（n = 92），排除合并细菌感染或 48 小时内死亡或接受临终关怀。
主要结局为全因 30 天死亡率。次要结局包括指南的依从性和治疗选择。通过 EQUAL 评分评估指南的依从性。
186 例念珠菌血症患者中，纳入 88 例 92 例患者的 92 例。66 例（71.7%）存在中心静脉导管（CVC），是最常见的感染源（N = 38，41.3%）。最常分离的物种是 （94 例中的 40 例，42.6%）。在 92 例念珠菌血症患者中，有 84 例（91.3%）进行了 IDC。IDC 组死亡率为 20.8%（16/77），无 IDC 组为 25%（2/8）（ =.67）。其他比较虽然数值不同，但没有统计学意义：重复血培养（98.8%对 87.5%； =.17）、超声心动图（70.2%对 50%； =.26）、CVC 移除（91.7%对 83.3%； =.45）和初始棘白菌素治疗（67.9%对 50%； =.44）。IDC 导致更多的眼科检查（67.9%对 12.5%； =.0035）。所有患者均接受抗真菌治疗。在 19 例（20.7%）患者中进行了抗菌药物管理建议。有 CVC 的情况下 IDC 的中位数 EQUAL 评分更高（16 对 11； =.001），但无 CVC 时则不然（12 对 11.5； =.81）。
在积极的抗菌药物管理计划和高咨询率的情况下，念珠菌血症可能不需要强制性 IDC。
