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Impact of an A ntimicrobial S tewardship P rogram C omprehensive C are B undle on M anagement of C andidemia
Author(s) -
Antworth Allen,
Collins Curtis D.,
Kunapuli Anjly,
Klein Kristin,
Carver Peggy,
Gandhi Tejal,
Washer Laraine,
Nagel Jerod L.
Publication year - 2013
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.1186
Subject(s) - antifungal , medicine , dermatology
Study Objective To analyze the impact of a comprehensive care bundle directed by an antimicrobial stewardship team ( AST ) on the management of candidemia. Design Single‐center, quasi‐experimental study. Setting A 930‐bed academic hospital. Patients Seventy‐eight patients with candidemia were evaluated; 41 patients received the candidemia care bundle ( AST group), and 37 did not (historical control group). Measurements and Main Results A candidemia care bundle was developed by an interdisciplinary AST , incorporating key elements from the I nfectious D iseases S ociety of A merica's C linical P ractice G uidelines for the M anagement of C andidemia. The AST made prospective recommendations in accordance with the care bundle. Bundle elements were utilization of appropriate antifungal agents with appropriate duration of use, removal of intravenous catheters, repeat blood cultures, monitoring of time until clearance of candidemia, and performance of ophthalmologic examinations. Compliance with all candidemia care bundle elements was significantly higher in the AST group versus the control group (78.0% vs 40.5%, p=0.0016). Implementation of the care bundle significantly improved rates of ophthalmologic examination (97.6% vs 75.7%, p=0.0108), selection of appropriate antifungal therapy (100% vs 86.5%, p=0.0488), and compliance with an appropriate duration of therapy (97.6% vs 67.7%, p=0.0012). In addition, the AST group had fewer excess total days of therapy beyond the recommended duration than the control group (5 vs 83 total antifungal days). Length of hospitalization (20 vs 21 days, p=0.9184), time until clearance of candidemia (3 vs 3 days p=0.610), rate of persistent candidemia (22% vs 40.5%, p=0.126), and rate of recurrent candidemia (4.9% vs 5.4%, p=0.916) were similar in the AST group versus the control group. Conclusion A comprehensive candidemia care bundle directed by our institution's AST improved the management of patients with candidemia. We encourage further exploration into the use of care bundles by AST s as part of their multifaceted approach to promoting appropriate antimicrobial utilization and optimizing the management of patients with infectious diseases.