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.


METHODS
Retrospective cohort study of patients with Candida BSI, comparing the prognosis of patients before and after the start of the intervention.


METHODS
A 1,240-bed, tertiary care university hospital.


METHODS
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).


METHODS
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; P=.04 by Fisher's exact test). More patients in the intervention group than in the baseline group received appropriate antifungal therapy (81% vs 50%) and had their central venous catheter removed at an appropriate time (95% vs 81%).


CONCLUSIONS
The introduction of an active system of IDP consultation for every case of Candida BSI in our hospital substantially improved patient outcomes.
Takakura
Shunji
S
Department of Infection Control and Prevention, Kyoto University Graduate School of Medicine, Kyoto, Japan. stakakr@kuhp.kyoto-u.ac.jp
Fujihara
Naoko
N
Saito
Takashi
T
Kimoto
Terumi
T
Ito
Yutaka
Y
Iinuma
Yoshitsugu
Y
Ichiyama
Satoshi
S
D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002175:Candida / Q000145:classification* / Q000302:isolation & purification; D002177:Candidiasis / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012017:Referral and Consultation; D012189:Retrospective Studies
D000935:Antifungal Agents