Impact of Infectious Diseases Consultation on Mortality in Patients with Candidemia

Abstract

BackgroundAn infectious diseases (ID) consultation is often, but not always, obtained to help guide treatment of patients with candidemia. We examined if ID consultation affected patient outcome in patients with culture positive candidemia.MethodsWe assembled a retrospective cohort of 1,873 cases of candidemia in patients hospitalized in our academic tertiary care hospital from 2002 to 2015. We collected data on comorbidities, predisposing factors; antifungal therapy, survival and ID consult. Patients who died within 24 hours of diagnosis were excluded, under the presumption that they did not have an opportunity to receive an ID consult. Survival analysis was performed via univariate and multivariate Cox Regression with censoring at 90 days, as subsequent mortality was less likely to be related to candidemia.Results913 (49%) of the candidemic patients received an ID consult; 960 (51%) did not. Underlying comorbidities were evenly distributed between patients with and without an ID consult, except that patients with an ID consult more frequently had a central line (39% vs. 26%, p < 0.001), were on mechanical ventilation (4% vs. 2%, P = 0.003) or were receiving extracorporeal membrane oxygenation (2.2% vs. 0.5%, p = 0.002). The ID consult group had lower 90-day mortality compared with patients without an ID consult (34% vs. 49%, P < 0.001), with an adjusted hazard ratio of mortality for those patients receiving an ID consult of 0.55 (95% CI: 0.48, 0.64, P < 0.001) (Fig 1). Patient management differed significantly: the ID consult group was more likely to receive an echinocandin (29% vs. 21%, P < 0.001) or amphotericin B (AmB) (3.4% vs. 1.4%, P = 0.006).ConclusionCandidemic patients who received an ID consult were significantly less likely to die, and were more likely to receive therapy with amphotericin or an echinocandin. These data suggest that an ID consult should be an integral part of clinical care of patients with candidemia.Figure 1.Survival curve of 1,873 patients with candidemia by receipt of ID consult adjusted for age above 50, receipt of chemotherapy, the presence of central line, previous use of corticosteroids, receipt of ECMO and recent `pleural procedure.Disclosures W. Powderly, Merck: Grant Investigator and Scientific Advisor, Consulting fee and Research grant; Gilead: Scientific Advisor, Consulting fee; Astellas: Grant Investigator, Research grant; A. Spec, Astellas Pharma US, Inc.: Grant Investigator, Research grant

The impact of infectious disease consultation in candidemia in a tertiary care hospital in Japan over 12 years

“…Besides antifungal therapy, adequate source control is an important component of appropriate candidemia management. While previous research has reported that removal of CVC was more frequent in the IDC group than in the non-IDC group [13–16, 26], our results showed no statistical difference in numbers of removal of CVC between both groups. In our study, we found that the IDC group had a statistically higher proportion of the removal of peripheral-line than the non-IDC group (OR = 2.91; 95% CI = 1.21–6.97; P = 0.013), which, to the best of our knowledge, has not been reported previously.…”

“…In fact, the proportion of PLAC was higher in the IDC group than the non-IDC group (OR = 2.34; 95% CI = 1.13–4.87; P = 0.020). Similar to a past study [26], our study revealed that consultation with an ophthalmologist was conducted more often in the IDC group then in the non-IDC group (OR = 6.68; 95% CI = 3.92–11.38; P < 0.001). For candidemia, the evaluation of endophthalmitis is thought to be a predictive factor for outcome improvement of candidemia, and contributes to an appropriate choice and duration of antifungal therapy [20, 27].…”