Adherence to National Consensus Guidelines and Association with Clinical Outcomes in Patients with Candidemia

Abstract

Background: National consensus guidelines outline recommendations for best practices in treating patients with candidemia. This study evaluated the impact of receiving care adherent to the best practice recommendations on clinical outcomes in patients with candidemia. Methods: This retrospective, multicenter study included patients with candidemia from 2010 to 2015 at 9 hospitals. The primary outcome was the composite of 30-day in-hospital mortality and 90-day candidemia recurrence. Outcomes were compared between those receiving and not receiving care adherent to the guideline recommendations. Inverse probability weights with regression adjustment were utilized to determine the average treatment effect of adherent care on the composite outcome Results: 295 patients were included with 14.2% meeting criteria for the composite outcome (11.9% mortality and 2.4% recurrence). The average treatment effect of adherent care was not significant ( P = .75). However, receiving appropriate initial antifungal treatment and central venous catheter removal were both associated with the composite (average treatment effect of −17.5%, P = .011 and −8.8%, P = .013, respectively). In patients with a source of infection other than the central line, central venous catheter removal was not associated with the composite ( P = .95). The most common reason for failure to receive appropriate initial antifungal treatment was omission of the loading dose. Conclusions: Central venous catheter removal and appropriate initial antifungal treatment were associated with a lower incidence of the composite of mortality and recurrence. Additional studies are needed to determine the optimal duration of therapy following candidemia clearance.

Impact of Invasive Fungal Diseases on Survival under Veno-Venous Extracorporeal Membrane Oxygenation for ARDS

“…Furthermore, this is especially true in the case of additional renal failure with renal replacement therapy. All current guidelines also recommend the removal of central lines in CBSI, which is further supported by recent studies [ 24 , 34 , 43 , 44 , 45 , 46 ]. Since ECMO cannulas cannot usually be exchanged or removed, this recommendation is difficult to fulfill.…”

Echinocandin use in an Australian tertiary hospital: implications for antifungal stewardship

“…Junco et al 18 assessed guideline adherence to the US National Consensus Guidelines for Candidemia and demonstrated a much lower rate of adherence (31.3% [50/160]) for initial echinocandin dose. We propose the differences in adherence may be due to the guidelines used.…”

“…We propose the differences in adherence may be due to the guidelines used. Many international studies assess guideline adherence of candidemia management, 18,19 assessing antifungal use, and a suite of other recommendations, including the removal of central venous catheters (CVCs) and repeat blood cultures. 5 Study heterogeneity makes it challenging to compare literature assessing antifungal choice, guideline compliance, and appropriateness.…”

Questioning the 14‐day dogma in candidemia treatment duration

“…Notably, the study showed no higher mortality or recurrence based on treatment duration but highlighted that the most common reason for failure to receive appropriate initial antifungal treatment was omission of the loading dose (Table 1). 27 …”

“…While investigating late recurrence of candidemia, defined by two episodes of candidemia at least 30 days apart, several available reports suggest that treatment duration might not exert a significant impact on recurrence rates or even survival outcomes 21,27 . This finding highlights the intricate nature of candidemia as a medical entity and emphasises the need for a comprehensive assessment when determining the optimal treatment duration for individual patients.…”