Impact of automatic infectious diseases consultation on the management of fungemia at a large academic medical center

被引:12
作者
Jones, Travis M. [1 ,2 ]
Drew, Richard H. [1 ,2 ]
Wilson, Dustin T. [2 ,3 ]
Sarubbi, Christina [3 ]
Anderson, Deverick J. [1 ]
机构
[1] Duke Univ, Med Ctr, Div Infect Dis, Durham, NC 27708 USA
[2] Campbell Univ, Coll Pharm & Hlth Sci, Dept Pharm Practice, Buies Creek, NC 27506 USA
[3] Duke Univ, Med Ctr, Dept Pharm, Durham, NC USA
关键词
antifungal agents; Candida; candidemia; consult; fungemia; stewardship; CLINICAL-PRACTICE GUIDELINES; NOSOCOMIAL FUNGAL-INFECTIONS; CANDIDEMIA; AMERICA; SOCIETY; EPIDEMIOLOGY; CANDIDIASIS; MORTALITY; UPDATE; PREVENTION;
D O I
10.2146/ajhp170113
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Purpose. The impact of automatic infectious diseases (ID) consultation for inpatients with fungemia at a large academic medical center was studied. Methods. In this single-center, retrospective study, the time to appropriate antifungal therapy before and after implementing a policy requiring automatic ID consultation for the management of fungemia for all patients with an inpatient positive blood culture for fungus was examined. The rates of ID consultation; the likelihood of receiving appropriate antifungal therapy; central venous catheter (CVC) removal rates; performance of ophthalmologic examinations; infection-related length of stay (LOS); rates of all-cause inhospital mortality, death, or transfer to an intensive care unit within 7 days of first culture; and inpatient cost of antifungals were also evaluated. Results. A total of 173 unique episodes (94 and 79 in the control and intervention groups, respectively) were included. Candida species were the most frequently cultured organisms, isolated from over 90% of patients in both groups. No differences were observed between the control and intervention groups in time to appropriate therapy, infection-related LOS, or time to CVC removal. However, patients in the intervention group were more likely than those in the control group to receive appropriate antifungal therapy (p = 0.0392), undergo ophthalmologic examination (p = 0.003), have their CVC removed (p = 0.0038), and receive ID consultation (p = 0.0123). Inpatient antifungal costs were significantly higher in the intervention group (p = 0.0177). Conclusion. While automatic ID consultation for inpatients with fungemia did not affect the time to administration of appropriate therapy, improvement was observed for several process indicators, including rates of appropriate antifungal therapy selection, time to removal of CVCs, and performance of ophthalmologic examinations.
引用
收藏
页码:1997 / 2003
页数:7
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