Improved clinical outcome of patients with Candida bloodstream infections through direct consultation by infectious diseases physicians in a Japanese university hospital

Objective. To examine whether intervention by infectious diseases physicians ( IDPs) in the treatment decisions that emphasize adequate antifungal treatment and early removal of central venous catheter for patients with Candida bloodstream infection ( BSI) improves prognosis. Design. Retrospective cohort study of patients with Candida BSI, comparing the prognosis of patients before and after the start of the intervention. setting. A 1,240- bed, tertiary care university hospital. Patients. Forty patients with Candida BSI during a 2- year period, from January 2001 to December 2002, were included in the study. Twenty- three patients in the first year after the start of intervention by IDPs ( intervention group) were compared with 17 patients in the first year before the start of the IDP intervention ( baseline group). Interventions. In January 2002, a total of 5 IDPs at Kyoto University Hospital gave unsolicited recommendations on antifungal treatment and advised all physicians treating inpatients who had Candida BSI to remove the central venous catheter. Results. No significant difference was seen between the 2 groups in patients' clinical background, species, and fluconazole susceptibility of the causative organisms. The 30- day survival rate was significantly better in the intervention group ( 18 [ 78%] of 23 patients) than in the baseline group ( 7 [ 44%] of 16 patients; by Fisher's exact test). More patients in the intervention group than in the baseline Pp. 04 group received appropriate antifungal therapy ( 81% vs 50%) and had their central venous catheter removed at an appropriate time ( 95% vs 81%) Conclusion. The introduction of an active system of IDP consultation for every case of Candida BSI in our hospital substantially improved patient outcomes.