Systematic clinical management of patients with candidemia improves survival - 19/07/18
, Marta Camici a, Riccardo Torelli b, Giulio Ventura a, Giancarlo Scoppettuolo a, Maurizio Sanguinetti b, Roberto Cauda a, Massimo Fantoni aHighlights |
• | Candidemia is a high-mortality disease, keystone of antifungal stewardship programs. |
• | Clinical management includes both therapeutic and non-therapeutic aspects of care. |
• | A systematic clinical management is difficult to achieve in clinical practice. |
• | An appropriate and systematic clinical approach to candidemia improves survival. |
Summary |
Objectives |
Taking into account the significant morbidity, mortality, and hospital costs related to Candidemia, our objective is to define if improving appropriateness in candidemia management was associated with better clinical outcomes.
Methods |
A prospective observational monocentric cohort study was conducted. Adherence to five main elements was examined: appropriate selection of initial therapy; follow-up blood culture; echocardiography; ophthalmological examination; and removal of a central venous catheter. The correlation between the number of appropriate elements achieved and 30 day survival was examined.
Results |
Patients with candidemia (n = 213) were enrolled. Adherence to all five elements was achieved in 36 cases (16.9%), while the majority adhered to three or four elements (28.2% and 37.1%, respectively). Multivariable Cox regression analysis revealed that the number of elements achieved was associated with survival [HR: 0.39 (0.30–0.52); p < 0.001]. Also, the number of elements achieved correlated positively with duration of therapy (p = 0.01), but not length of hospital stay (p = 0.56).
Conclusions |
Five elements, including therapeutic and non-therapeutic-related aspects, of care were good indicators of appropriate management of patients with candidemia. Implementation of evidence-based practice regarding optimal clinical management is crucial for any antimicrobial stewardship program.
Le texte complet de cet article est disponible en PDF.Keywords : Candidemia, Antibiotic stewardship, Bloodstream infections, Appropriateness
Plan
Vol 77 - N° 2
P. 145-150 - août 2018 Retour au numéro
Article précédent
- NLRP3 inflammasome is involved in the recognition of Paracoccidioides brasiliensis by human dendritic cells and in the induction of Th17 cells
- Lívia Furquim de Castro, Larissa Nara Alegrini Longhi, Munir Regini Paião, Amauri da Silva Justo-Júnior, Marcelo Bispo de Jesus, Maria Heloisa de Souza Lima Blotta, Ronei Luciano Mamoni
- Candida periprosthetic joint infection: A rare and difficult-to-treat infection
- Laura Escolà-Vergé, Dolors Rodríguez-Pardo, Jaime Lora-Tamayo, Laura Morata, Oscar Murillo, Helem Vilchez, Luisa Sorli, Laura Guío Carrión, José Mª Barbero, Julián Palomino-Nicás, Alberto Bahamonde, Alfredo Jover-Sáenz, Natividad Benito, Rosa Escudero, Marta Fernandez Sampedro, Rafael Pérez Vidal, Lucía Gómez, Pablo S. Corona, Benito Almirante, Javier Ariza, Carles Pigrau, Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), and the Spanish Network for Research in Infectious Pathology (REIPI)
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?