Hostname: page-component-76fb5796d-vvkck Total loading time: 0 Render date: 2024-04-26T20:02:16.041Z Has data issue: false hasContentIssue false
  • English
  • Français

Improved Clinical Outcome of Patients With Candida Bloodstream Infections Through Direct Consultation by Infectious Diseases Physicians in a Japanese University Hospital

Published online by Cambridge University Press:  21 June 2016

Shunji Takakura ,
Naoko Fujihara ,
Takashi Saito ,
Terumi Kimoto ,
Yutaka Ito ,
Yoshitsugu Iinuma  and
Satoshi Ichiyama
Shunji Takakura*
Affiliation:
Departments of Infection Control and Prevention, Kyoto University Graduate School of Medicine, Kyoto, Japan Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
Naoko Fujihara
Affiliation:
Departments of Infection Control and Prevention, Kyoto University Graduate School of Medicine, Kyoto, Japan Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
Takashi Saito
Affiliation:
Departments of Infection Control and Prevention, Kyoto University Graduate School of Medicine, Kyoto, Japan Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
Terumi Kimoto
Affiliation:
Departments of Infection Control and Prevention, Kyoto University Graduate School of Medicine, Kyoto, Japan Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
Yutaka Ito
Affiliation:
Departments of Infection Control and Prevention, Kyoto University Graduate School of Medicine, Kyoto, Japan Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
Yoshitsugu Iinuma
Affiliation:
Departments of Infection Control and Prevention, Kyoto University Graduate School of Medicine, Kyoto, Japan Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
Satoshi Ichiyama
Affiliation:
Departments of Infection Control and Prevention, Kyoto University Graduate School of Medicine, Kyoto, Japan Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
*
Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, 6068507, Japan, (stakakr@kuhp.kyoto-u.ac.jp)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To examine whether intervention by infectious diseases physicians (IDPs) in the treatment decisions that emphasize adequate antifungal treatment and early removal of central venous catheter for patients with Candida bloodstream infection (BSI) improves prognosis.

Design.

Retrospective cohort study of patients with Candida BSI, comparing the prognosis of patients before and after the start of the intervention.

Setting.

A 1,240-bed, tertiary care university hospital.

Patients.

Forty patients with Candida BSI during a 2-year period, from January 2001 to December 2002, were included in the study Twenty-three patients in the first year after the start of intervention by IDPs (intervention group) were compared with 17 patients in the first year before the start of the IDP intervention (baseline group).

Interventions.

In January 2002, a total of 5 IDPs at Kyoto University Hospital gave unsolicited recommendations on antifungal treatment and advised all physicians treating inpatients who had Candida BSI to remove the central venous catheter.

Results.

No significant difference was seen between the 2 groups in patients' clinical background, species, and fluconazole susceptibility of the causative organisms. The 30-day survival rate was significantly better in the intervention group (18 [78%] of 23 patients) than in the baseline group (7 [44%] of 16 patients; P = .04 by Fisher's exact test). More patients in the intervention group than in the baseline group received appropriate antifungal therapy (81% vs 50%) and had their central venous catheter removed at an appropriate time (95% vs 81%)

Conclusion.

The introduction of an active system of IDP consultation for every case of Candida BSI in our hospital substantially improved patient outcomes.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 9 , September 2006 , pp. 964 - 968
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.John, JF Jr, Fishman, NO. Programmatic role of the infectious diseases physician in controlling antimicrobial costs in the hospital. Clin Infect Dis 1997; 24:471–485.CrossRefGoogle ScholarPubMed
2.Yinnon, AM. Whither infectious diseases consultations? Analysis of 14,005 consultations from a 5-year period. Clin Infect Dis 2001; 33:1661–1667.Google Scholar
3.Gums, JG, Yancey, RW Jr, Hamilton, CA, et al. A randomized, prospective study measuring outcomes after antibiotic therapy intervention by a multidisciplinary consult team. Pharmacotherapy 1999; 19:1369–1377.Google Scholar
4.Fox, BC, Imrey, PB, Voights, MB, et al. Infectious disease consultation and microbiologic surveillance for intensive care unit trauma patients: a pilot study. Clin Infect Dis 2001; 33:1981–1989.CrossRefGoogle ScholarPubMed
5.Lobati, F, Herndon, B, Bamberger, D. Osteomyelitis: etiology, diagnosis, treatment and outcome in a public versus a private institution. Infection 2001; 29:333–336.CrossRefGoogle Scholar
6.Fowler, VG Jr, Sanders, LL, Sexton, DJ, et al. Outcome of Staphylococcus aureus bacteremia according to compliance with recommendations of infectious diseases specialists: experience with 244 patients. Clin Infect Dis 1998; 27:478–486.Google Scholar
7.Wey, SB, Mori, M, Pfaller, MA, et al. Hospital-acquired candidemia: the attributable mortality and excess length of stay. Arch Intern Med 1988; 148:2642–2645.Google Scholar
8.Gudlaugsson, O, Gillespie, S, Lee, K, et al. Attributable mortality of nosocomial candidemia, revisited. Clin Infect Dis 2003; 37:1172–1177.Google Scholar
9.Fridkin, SK, Jarvis, WR. Epidemiology of nosocomial fungal infections. Clin Microbiol Rev 1996; 9:499–511.Google Scholar
10.Hung, CC, Chen, YC, Chang, SC, et al. Nosocomial candidemia in a university hospital in Taiwan. J Formosan Med Assoc 1996; 95:19–28.Google Scholar
11.Nucci, M, Colombo, AL, Silveira, F, et al. Risk factors for death in patients with candidemia. Infect Control Hosp Epidemiol 1998; 19:846–850.Google Scholar
12.Nguyen, MH, Peacock, JE Jr, Tanner, DC, et al. Therapeutic approaches in patients with candidemia: evaluation in a multicenter, prospective, observational study. Arch Intern Med 1995; 155:2429–2935.Google Scholar
13.Luzzati, R, Amalfitano, G, Lazzarini, L, et al. Nosocomial candidemia in non-neutropenic patients at an Italian tertiary care hospital. Eur J Clin Microbiol Infect Dis 2000; 19:602–607.CrossRefGoogle ScholarPubMed
14.Nucci, M, Anaissie, E. Should vascular catheters be removed from all patients with candidemia? An evidence-based review. Clin Infect Dis 2002; 34:591–599.Google Scholar
15.Takakura, S, Fujihara, N, Saito, T, et al. Clinical factors associated with fluconazole resistance and short-term survival in patients with Candida bloodstream infection. Eur J Clin Microbiol Infect Dis 2004; 23:380–388.Google Scholar
16.Natsch, S, Steeghs, MH, Hekster, YA, et al. Use of fluconazole in daily practice: still room for improvement. J Antimicrob Chemother 2001; 48: 303–310.Google Scholar
17.Rex, JH, Walsh, TJ, Sobel, JD, et al. Practice guidelines for the treatment of candidiasis. Clin Infect Dis 2000; 30:662–678.CrossRefGoogle ScholarPubMed
18.Gilbert, DN, Moellering, RC Jr, Sande, MA, eds. The Sanford Guide to Antimicrobial Therapy. 31st ed. Hyde Park, VT: Antimicrobial Therapy; 2001.Google Scholar
19.Warren, NG, Hazen, KC. Candida, Cryptococcus, and other yeasts of medical importance. In: Murray, PR, Baron, EJ, Pfaller, MA, Tenover, FC, Yolken, RH, eds. Manual of Clinical Microbiology. 7th ed. Washington, DC: ASM Press; 1999:1184–1199.Google Scholar
20.National Committee for Clinical Laboratory Standards. Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts: Approved Standard M27-A2. Wayne, PA: NCCLS; 2002.Google Scholar