Open AccessAntimicrobial stewardship without infectious disease physician for patients with candidemia: A before and after study
Author(s) -
Murakami Minoru,
Komatsu Hirokazu,
Sugiyama Masahide,
Ichikawa Yuhei,
Ide Kyoko,
Tsuchiya Rumi,
Kunieda Kenji,
Magishi Akiko,
Akiyama Gaku,
Miura Fumihide,
Okada Kunihiko,
Ikezoe Masaya
Publication year - 2018
Publication title -
journal of general and family medicine
Language(s) - English
Resource type - Journals
ISSN - 2189-7948
DOI - 10.1002/jgf2.159
Subject(s) - medicine , antimicrobial stewardship , hazard ratio , infectious disease (medical specialty) , guideline , emergency medicine , disease , intensive care medicine , confidence interval , antibiotics , pathology , antibiotic resistance , microbiology and biotechnology , biology
Background Little is known about the effects of antimicrobial stewardship team ( AST ) without infectious disease physician ( IDP ) on clinical outcome in patients with candidemia. Methods We conducted a before and after study involving patients with hospital‐acquired candidemia at a tertiary hospital without IDP s. The AST consisted of physicians, pharmacists, nurse, microbiologist, and administrative staff. A candidemia care bundle was developed based on the Infectious Disease Society of America ( IDSA ) guideline. The non‐ IDP AST provided recommendations to the attending physicians whose patients developed candidemia during hospitalization. The primary outcome was 30‐day all‐cause mortality, while the secondary outcomes were adherence to the IDSA guidelines regarding the management of candidemia. Data of up to 3 years of preintervention and 3 years of intervention period were analyzed. Results By 30 days, 11 of 46 patients (23.9%) in the intervention group and 7 of 30 patients (23.3%) in the preintervention group died (adjusted hazard ratio for the intervention group: 0.68 [95% CI 0.24‐1.91]). The non‐ IDP AST was associated with appropriate empirical antifungal therapy (100% vs 60.0%; proportion ratio 1.67 [95% CI 1.24‐2.23]), appropriate duration of treatment (84.7% vs 43.3%; 1.96 [1.28‐3.00]), removal of central venous catheters (94.4% vs 70.8%; 1.33 [1.02‐1.74]), and ophthalmological examination (93.5% vs 63.3%; 1.48 [1.12‐1.96]). Conclusions Although we found no significant difference in 30‐day mortality, the non‐ IDP AST was associated with improved adherence to guidelines for management of candidemia.