Speight Carly C, Williamson Julie E, Ebied Alex M, Medaris Leigh Ann, McCurdy Lewis, Hammer Katie L
Department of Pharmacy, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, USA.
Antimicrobial Support Network, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, USA.
Open Forum Infect Dis. 2023 Jul 20;10(8):ofad388. doi: 10.1093/ofid/ofad388. eCollection 2023 Aug.
Infectious diseases consultation improves outcomes in patients with candidemia, although some facilities lack access to consultation. This multisite health care system study compared in-hospital mortality in patients with candidemia across 3 groups-those who received on-site consultation, telemedicine consultation, or no consultation. All patients were reviewed by an antimicrobial stewardship pharmacist.
A retrospective observational cohort study was performed of adult hospitalized patients with candidemia from January 2018 to October 2021. The primary outcome was in-hospital mortality. Secondary outcomes included receipt and duration of antifungals, removal of central venous lines if present, ophthalmologic examination, echocardiography, and determination of infection source.
A total of 265 patients were evaluated: 187 in the on-site consultation group, 49 in the telemedicine consultation group, and 29 in the nonconsultation group. Although in-hospital mortality did not differ significantly between the on-site and nonconsultation groups, it was significantly lower in the telemedicine group when compared with the nonconsultation group (10.2% vs 34.5%, = .009). Patients who received on-site or telemedicine consultation had significantly more antifungal therapy initiated, appropriate therapy duration, central lines removed, and echocardiography performed, as well as fewer unknown candidemia sources, vs those in the nonconsultation group.
This is the first study of a multisite health care system providing telemedicine services to evaluate the impact of infectious diseases consultation on candidemia mortality. These findings suggest that when on-site consultation is unavailable, infectious diseases telemedicine consultation and antimicrobial stewardship can improve outcomes and should be considered for all patients with candidemia at resource-limited sites.
感染病会诊可改善念珠菌血症患者的治疗结局，尽管一些机构无法获得会诊服务。这项多中心医疗系统研究比较了念珠菌血症患者中三组的院内死亡率，这三组分别是接受现场会诊、远程医疗会诊或未接受会诊的患者。所有患者均由抗菌药物管理药师进行评估。
对2018年1月至2021年10月期间成年住院念珠菌血症患者进行了一项回顾性观察队列研究。主要结局是院内死亡率。次要结局包括抗真菌药物的使用及持续时间、如有中心静脉导管则拔除情况、眼科检查、超声心动图检查以及感染源的确定。
共评估了265例患者：现场会诊组187例，远程医疗会诊组49例，未会诊组29例。尽管现场会诊组和未会诊组之间的院内死亡率无显著差异，但与未会诊组相比，远程医疗组的死亡率显著更低（10.2%对34.5%，P = 0.009）。与未会诊组相比，接受现场或远程医疗会诊的患者启动抗真菌治疗的比例显著更高、治疗疗程合适、中心静脉导管拔除率更高、超声心动图检查执行率更高，且念珠菌血症来源不明的情况更少。
这是第一项关于多中心医疗系统提供远程医疗服务以评估感染病会诊对念珠菌血症死亡率影响的研究。这些发现表明，当无法进行现场会诊时，感染病远程医疗会诊和抗菌药物管理可改善治疗结局，资源有限地区的所有念珠菌血症患者均应考虑采用。
