Antimicrobial stewardship without infectious disease physician for patients with candidemia: A before and after study

Abstract

BackgroundLittle is known about the effects of antimicrobial stewardship team (AST) without infectious disease physician (IDP) on clinical outcome in patients with candidemia.MethodsWe conducted a before and after study involving patients with hospital‐acquired candidemia at a tertiary hospital without IDPs. 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.ResultsBy 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]).ConclusionsAlthough we found no significant difference in 30‐day mortality, the non‐IDP AST was associated with improved adherence to guidelines for management of candidemia.

Author Reply to the Letter to the Editor: Antimicrobial stewardship without infectious disease physician

“…It was difficult to find other reasons apart from the three likely explanations stated in the Discussion section of our paper2 because this was the first report to suggest the association between non‐IDP AST and improved adherence to the guidelines in patients with candidemia. As pointed out in the Letter to the Editor, 1 the clinical judgment of the IDP is considered the most important aspect of management that can reduce the mortality rate in candidemia.…”

“…We thank the author of the Letter to the Editor 1 for his interest in our article published recently in this journal 2. First, the author was interested in further information on the prognosis of the five patients of the preintervention group who received no antifungal treatment.…”

Association between the transtheoretical model approach and sustained intradialytic pedaling exercise

“…This retrospective cohort study was conducted at Saku Central Hospital, one of the largest hospitals in eastern Nagano Prefecture, Japan. [ 31 ] Although no full-time transplant surgeons and infectious disease physicians have ever worked in this facility, [ 32 ] it is the only hospital in the area where patients with ESKD can receive living-donor kidney transplantation. [ 33 ] There are 46 beds and 5 full-time nephrologists in the dialysis unit.…”

Knowledge Does Not Correlate with Behavior toward Deceased Organ Donation: A Cross-Sectional Study in Japan

“…The group consists of 15 medical facilities: 3 clinical hospitals, 2 geriatric health services facilities, 6 home-visit nursing stations, 2 institutions that provide rural medicine and oriental medicine, 1 clinic, and 1 healthcare center. Although Saku Central Hospital Advanced Care Center, the largest of the 3 clinical hospitals, is a 450-bed tertiary hospital, no full-time transplant surgeons or infectious disease physicians had ever worked in the facility [34]. Therefore, only a few living donor kidney transplantations are performed each year in that Center.…”